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Curatola N, Prasad P, Bell BK, Fang MC, Rambachan A. Assessing for differences in opioid administration during inpatient end-of-life care for patients with limited English proficiency. J Hosp Med 2024; 19:596-604. [PMID: 38544317 PMCID: PMC11222029 DOI: 10.1002/jhm.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) may have worse health outcomes and differences in processes of care. Language status may particularly affect situations that depend on communication, such as symptom management or end-of-life (EOL) care. OBJECTIVE The objective of this study was to assess whether opioid prescribing and administration differs by English proficiency (EP) status among hospitalized patients receiving EOL care. METHODS This single-center retrospective study identified all adult patients receiving "comfort care" on the general medicine service from January 2013 to September 2021. We assessed for differences in the quantity of opioids administered (measured by oral morphine equivalents [OME]) by patient LEP status using multivariable linear regression, controlling for other patient and medical factors. RESULTS We identified 2652 patients receiving comfort care at our institution during the time period, of whom 1813 (68%) died during the hospitalization. There were no significant differences by LEP status in terms of mean OME per day (LEP received 30.8 fewer OME compared to EP, p = .91) or in the final 24 h before discharge (LEP received 61.7 more OME compared to EP, p = .80). CONCLUSION LEP was not associated with differences in the amount of opioids received for patients whose EOL management involved standardized order sets for symptom management at our hospital.
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Affiliation(s)
- Nicole Curatola
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Priya Prasad
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brieze K. Bell
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Margaret C. Fang
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Aksharananda Rambachan
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
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Hamina A, Muller AE, Clausen T, Skurtveit S, Hesse M, Tjagvad C, Thylstrup B, Odsbu I, Zoega H, Jónsdóttir HL, Taipale H. Prescription opioids among older adults: ten years of data across five countries. BMC Geriatr 2022; 22:429. [PMID: 35578167 PMCID: PMC9112605 DOI: 10.1186/s12877-022-03125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 05/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Opioid use has increased globally in the recent decade. Although pain remains a significant problem among older adults, susceptibility to opioid-related harms highlights the importance of careful opioid therapy monitoring on individual and societal levels. We aimed to describe the trends of prescription opioid utilisation among residents aged ≥65 in all Nordic countries during 2009-2018. METHODS We conducted cross-sectional measurements of opioid utilisation in 2009-2018 from nationwide registers of dispensed drugs in Denmark, Finland, Iceland, Norway, and Sweden. The measures included annual opioid prevalence, defined daily doses (DDDs) per 1000 inhabitants per day (DIDs), and morphine milligram equivalents (MMEs) per user per day. RESULTS From 2009 to 2018, an average of 808,584 of adults aged ≥65 used opioids yearly in all five countries; an average annual prevalence of 17.0%. During this time period, the prevalence decreased in Denmark, Norway, and Sweden due to declining codeine and/or tramadol use. Iceland had the highest opioid prevalence in 2009 (30.2%), increasing to 31.7% in 2018. In the same period, DIDs decreased in all five countries, and ranged from 28.3 in Finland to 58.5 in Denmark in 2009, and from 23.0 in Finland to 54.6 in Iceland in 2018. MMEs/user/day ranged from 4.4 in Iceland to 19.6 in Denmark in 2009, and from 4.6 in Iceland to 18.8 in Denmark in 2018. In Finland, Norway, and Sweden, MMEs/user/day increased from 2009 to 2018, mainly due to increasing oxycodone utilisation. CONCLUSIONS The stable or decreasing opioid utilisation prevalence among a majority of older adults across the Nordic countries coincides with an increase in treatment intensity in 2009-2018. We found large cross-national differences despite similarities across the countries' cultures and healthcare systems. For the aged population, national efforts should be placed on improving pain management and monitoring future trends of especially oxycodone utilisation.
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Affiliation(s)
- A. Hamina
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway ,grid.9668.10000 0001 0726 2490School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - A. E. Muller
- grid.418193.60000 0001 1541 4204Division of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - T. Clausen
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway
| | - S. Skurtveit
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway ,grid.418193.60000 0001 1541 4204Department of Mental Disorders, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - M. Hesse
- grid.7048.b0000 0001 1956 2722Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - C. Tjagvad
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway
| | - B. Thylstrup
- grid.7048.b0000 0001 1956 2722Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - I. Odsbu
- grid.418193.60000 0001 1541 4204Department of Mental Disorders, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - H. Zoega
- grid.1005.40000 0004 4902 0432Centre for Big Data Research in Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia ,grid.14013.370000 0004 0640 0021Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - H. L. Jónsdóttir
- grid.14013.370000 0004 0640 0021Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland ,grid.14013.370000 0004 0640 0021Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - H. Taipale
- grid.9668.10000 0001 0726 2490School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.466951.90000 0004 0391 2072Niuvanniemi Hospital, Kuopio, Finland
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Geng X, Zhou S, Zhang X, Liu X, Cheng X, Jiang L, Zhang D. The Efficacy and Safety of Celecoxib for Pain Management After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Surg 2022; 9:791513. [PMID: 35155555 PMCID: PMC8831328 DOI: 10.3389/fsurg.2022.791513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to determine the efficacy and safety of celecoxib for pain management after total knee arthroplasty (TKA). Methods PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify eligible randomized controlled trials (RCTs) that compared celecoxib with a placebo in term of pain control efficacy after TKA. Primary outcomes included pain scores at 24, 48, and 72 h after TKA. Secondary outcomes included the active range of motion (ROM) at 24, 48,72 h, and 7 days postoperatively, morphine consumption over 72 h after TKA, incidence of postoperative nausea and vomiting (PONV), and total blood loss after surgery. Data analysis was conducted using RevMan version 5.3. Results Five RCTs involving 593 participants were included in the study. Compared with a placebo, celecoxib significantly reduced visual analog scale (VAS) scores at rest at 24 h [mean difference (MD) = −0.72; 95% confidence interval (CI), −1.27 to −0.17; I2 = 82%; P = 0.01], 48 h (MD = −1.51; 95% CI, −2.07 to −0.95; I2 = 0%; P < 0.00001), and 72 h (MD = −1.30; 95% CI, −2.07 to −0.54; I2 = 82%; P = 0.0009) after TKA, decreased morphine consumption over postoperative 72 h (MD = −0.73; 95% CI, −0.96 to −0.51; I2 = 96%; P < 0.00001), and increased active ROM at 48 h (MD = 13.23; 95% CI, 7.79 to 18.67; I2 = 0%; P < 0.00001), 72 h (MD = 6.52; 95% CI, 4.95 to 8.10; I2 = 68%; P < 0.00001), and 7 days (MD = 7.98; 95% CI, 3.64 to 12.31; I2 = 68%; P = 0.0003) after the operation. No significant difference was found in the active ROM at 24 h (MD = 7.60; 95% CI, −6.14 to 21.34; I2 = 94%; P = 0.28) and the incidence of PONV after surgery [risk ratio (RR) = 0.66; 95% CI, 0.40 to 1.09; I2 = 0%; P = 0.11]. Conclusion The administration of celecoxib is an effective and safe strategy for postoperative analgesia after TKA.
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Affiliation(s)
- Xiaoyuan Geng
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shangyou Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyan Zhang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xi Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xu Cheng
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lihua Jiang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Lihua Jiang
| | - Donghang Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- Donghang Zhang
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Dias J, Zaveri S, Divino C. Postoperative opioid prescribing patterns in the geriatric patient population. Am J Surg 2021; 224:418-422. [PMID: 34974887 DOI: 10.1016/j.amjsurg.2021.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioid prescription patterns in elderly patients undergoing general surgery are not well characterized. The purpose of this study was to identify trends in postoperative opioid prescriptions in geriatric patients undergoing general surgery procedures and determine prescribing differences between the geriatric and non-geriatric patient population. METHODS We retrospectively evaluated geriatric and non-geriatric patients undergoing the most frequently performed open and laparoscopic general surgery procedures at our institution from 2014 to 2019. Differences in opioid prescriptions between the groups were analyzed. RESULTS We identified 5874 non-geriatric and 3306 geriatrics patients who underwent the included procedures at our institution. 5169 (88.0%) of non-geriatric patients and 2692 (81.4%) of geriatric patients received a perioperative opioid prescription. While the vast majority of both groups were prescribed opioids, geriatric patients were less likely to receive an opioid prescription (p < 0.0001). Between 2016 and 2019, the amount of opioid prescribed in the geriatric population decreased each year (p < 0.0001). Prescription amounts were significantly higher in geriatric patients aged 65-74 compared to patients 85 or older (p < 0.0001). CONCLUSIONS Individuals older than 65 years of age represent a growing percent of the population and there is a need to better understand opioid prescribing practices in this complex patient group. Postoperative opioid prescribing patterns differ significantly between the geriatric and non-geriatric patient population and warrant further investigation.
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Affiliation(s)
- Jennifer Dias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Shruti Zaveri
- Department of Surgery, The Mount Sinai Hospital, New York, NY, USA.
| | - Celia Divino
- Department of Surgery, The Mount Sinai Hospital, New York, NY, USA.
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Neelamegam M, Zgibor J, Chen H, O’rourke K, Bakour C, Rajaram L, Anstey KJ. The effect of opioids on the cognitive function of older adults: results from the Personality and Total Health through life study. Age Ageing 2021; 50:1699-1708. [PMID: 33755047 PMCID: PMC8437064 DOI: 10.1093/ageing/afab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population. OBJECTIVE we examined the association between opioid use, and changes in cognitive function of older adults. DESIGN prospective study. SETTING community dwelling older adults. SUBJECTS study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health Through Life Study in Australia. METHODS medication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models. RESULTS cumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = -0.34, Model 2: β = -0.35 and Model 3: β = -0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use. CONCLUSION prolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.
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Affiliation(s)
- Malinee Neelamegam
- Yale School of Public Health, Yale University, New Haven, CT, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Janice Zgibor
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Henian Chen
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Kathleen O’rourke
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Chighaf Bakour
- College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Kaarin J Anstey
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
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Pharmacological treatment in the dying geriatric patient: describing use and dosage of opioids in the acute geriatric wards and palliative care units of three hospitals. Eur Geriatr Med 2021; 12:545-550. [PMID: 33880731 DOI: 10.1007/s41999-021-00496-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The quality of dying of the older person could be optimized. One of the cornerstones to achieve better symptom control in the dying patient can be the use of opioids. However, little benchmark data concerning the use and dosage of opioids in the terminal phase in older persons are available. METHODS In this multi-centric retrospective study, we included patients 75 years and older who died on the acute geriatric unit (AGU) and the palliative care unit (PCU) in three hospitals (during a 2-year period). Sudden deaths were excluded. Demographic and clinical variables, and data concerning use and dosage of opioids in the last 72 h before death were collected. RESULTS Data from 556 patients were collected (38.5% from PCU, 61.5% from AGU). Older patients on the PCU were younger and suffered more frequently from end-stage malignancies. Most older patients on PCU (98.2%) received opioids with a mean dosage of 88.2 mg in 72 h. On the AGU, 75.5% of patients was treated with opioids with a mean dosage of 27.7 mg in 72 h. After adjusting for the variables age, gender and underlying pathology, use of opioids (OR 11.9; 95% CI 2.7-51.7; p = 0.022) and dosage (B 28.8; 95% CI 4.1-53.4; p = 0.001) still differed between the PCU and the AGU. Dosage of opioids was also associated with suffering from cancer or not. CONCLUSIONS This descriptive benchmark study shows that opioids are given to 75.5% of dying older patients on the AGU at a mean dose of 27.7 mg over the last 72 h versus 98.2% and 88.2 mg, respectively, on the PCU. Further prospective studies including detailed information on symptomatology and more in-depth clinical information on trajectory of dying and cause of death are necessary.
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Campbell CL, Kelly M, Rovnyak V. Pain management in home hospice patients: A retrospective descriptive study. Nurs Health Sci 2017; 19:381-387. [PMID: 28612352 DOI: 10.1111/nhs.12359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 03/14/2017] [Accepted: 03/24/2017] [Indexed: 01/14/2023]
Abstract
The development and evaluation of evidence-based, safe, and effective home-based pain management models for caregivers implementation is receiving greater attention in the literature because of international initiatives intended to increase the number of people who receive end-of-life care in home-based settings. The purpose of this "retrospective descriptive design" study was to describe pharmacological pain management and outcomes for 40 cancer and non-cancer patients receiving hospice care at home. While the median pain score was higher at admission in the cancer group than in the hospice care at home group, the difference was not significant at or within 48 hour of admission. Overall, there was a significant decrease in pain from the first measurement to the second. Within the last seven days of life, the majority of participants were not able to provide a pain severity score when asked to evaluate the effectiveness of pain management, thus their caregiver provided a proxy evaluation. Pain management was effective in the home setting. More research is needed on the best methods to teach lay caregivers to assess pain and evaluate the effectiveness of pharmacological modalities to manage pain.
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Affiliation(s)
- Cathy L Campbell
- University of Virginia School of Nursing, Charlottesville, Virginia
| | - Meghan Kelly
- University of Virginia School of Nursing, Charlottesville, Virginia
| | - Virginia Rovnyak
- University of Virginia School of Nursing, Charlottesville, Virginia
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The efficacy of pregabalin for the management of postoperative pain in primary total knee and hip arthroplasty: a meta-analysis. J Orthop Surg Res 2017; 12:49. [PMID: 28340617 PMCID: PMC5366132 DOI: 10.1186/s13018-017-0540-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/09/2017] [Indexed: 11/22/2022] Open
Abstract
Objective A systematic review of randomized controlled trials (RCTs) was conducted to evaluate the efficacy of pregabalin for the management of postoperative pain in patients undergoing primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA). Method The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for related articles using search strategy. RevMan 5.3 software was selected to conduct the meta-analysis. Results Seven RCTs were included in our meta-analysis. There were significant differences in visual analogue scale (VAS) at 24 and 48 h with rest, knee flexion degree, mean morphine consumption, and postoperative side effects (nausea, vomiting, pruritus, and dizziness) when comparing the pregabalin group to the placebo group after TKA and THA. However, the differences in VAS at 72 h with rest and at 24 h on movement were not significant between the two groups. Conclusions Pregabalin was found to improve pain control at 24 and 48 h with rest, reduce morphine consumption, improve the knee flexion degree, decrease the incident rate of nausea, vomiting, and pruritus, and increase the incident rate of dizziness after TKA and THA but could not improve the pain control at 72 h with rest. In summary, the use of pregabalin may be a valuable asset in pain management within the first 48 h after TKA and THA. However, future studies regarding doses and pregabalin medication are required.
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Prevalence of Different Combinations of Antiepileptic Drugs and CNS Drugs in Elderly Home Care Service and Nursing Home Patients in Norway. EPILEPSY RESEARCH AND TREATMENT 2016; 2016:5153093. [PMID: 27525114 PMCID: PMC4971287 DOI: 10.1155/2016/5153093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/14/2016] [Indexed: 11/29/2022]
Abstract
Introduction. Antiepileptic drugs (AEDs) are used to treat different conditions in elderly patients and are among the drug classes most susceptible to be involved in drug-drug interactions (DDI). The aim of the study was to describe and compare use of AEDs between home care service and nursing home patients, as these patients are not included in nationwide databases of drug utilization. In the combined population, we investigate DDI of AEDs with other central nervous system- (CNS-) active drugs and DDIs involving AEDs in general. Materials and Methods. Point-prevalence study of Norwegian patients in home care services and nursing homes in 2009. At the patient level, we screened for different DDIs involving AEDs. Results. In total, 882 patients (7.8%) of 11,254 patients used AEDs and number of users did not differ between home care services and nursing homes (8.2% versus 7.7%). In the combined population, we identified 436 potential DDIs in 45% of the patients. Conclusions. In a large population of elderly, home care service and nursing home patients do not differ with respect to exposure of AEDs but use more AEDs as compared to the general population of similar age. The risk of DDIs with AEDs and other CNS-active drugs should be taken into consideration and individual clinical evaluations are assessed in this population.
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Prostran M, Vujović KS, Vučković S, Medić B, Srebro D, Divac N, Stojanović R, Vujović A, Jovanović L, Jotić A, Cerovac N. Pharmacotherapy of Pain in the Older Population: The Place of Opioids. Front Aging Neurosci 2016; 8:144. [PMID: 27378916 PMCID: PMC4909762 DOI: 10.3389/fnagi.2016.00144] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/02/2016] [Indexed: 01/25/2023] Open
Abstract
Pain is a common symptom in older people. It is possible that pain is underreported in older persons due to an incorrect belief that it is an inevitable part of aging. Opioid analgesics are potent medications, with confirmed efficacy for the treatment of moderate to severe pain. These drugs are commonly used in older persons. However, there is insufficient evidence regarding safety of opioids in older patients. One of the reasons for this is the lack of randomized, controlled clinical trials. People of advanced age often have comorbidites and use other prescription drugs, as well as over-the-counter (OTC) compounds, thus making them more suceptible to the risk of interactions with opioids. Significant pharmacokinetic and pharmacodynamic changes that occur with advancing age increase the risk of adverse effects of opioids. There are also some discrepancies between guidelines, which recommend the use of lower doses of opioids in older patients, and the findings in the literature which suggest that pain is often undertreated in this age group. It seems that there are significant variations in the tolerability of different opioid analgesics in older people. Morphine, fentanyl, oxycodone, and buprenorphine are still the preferred evidence-based choices for add-on opioid therapy for these patients. However, the safety and efficacy of other opioids in older patients, especially if comorbidities and polypharmacy are present, is still questionable. This review addresses the most important aspects of the use of opioids in older persons, focusing on pharmacokinetics, pharmacodynamics, adverse effects, and interactions.
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Affiliation(s)
- Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Katarina Savić Vujović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Sonja Vučković
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Branislava Medić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Dragana Srebro
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Nevena Divac
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Radan Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | | | - Lepa Jovanović
- Institute for Gerontology and Palliative Care Belgrade, Serbia
| | - Ana Jotić
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Nataša Cerovac
- Clinic for Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade Belgrade, Serbia
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Abstract
Escalating pain is common in the final weeks of life, requiring skilled management to assist patients with a life-limiting illness. Using a cancer model, pharmacologic approaches to treat pain in the final weeks of life are reviewed.
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Affiliation(s)
- Pamela Stitzlein Davies
- Pamela Stitzlein Davies is and NP and Pain Research Coordinator, Department of Psychiatry, at the University of Washington, Seattle, Wash
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Abstract
Persistent pain affects the elderly disproportionally, occurring in 50% of elderly community-dwelling patients and 80% of aged care residents. The management of pain in the elderly and frail patient is complicated because of the risks posed by changes in pharmacokinetics and pharmacodynamics, polypharmacy, and drug-disease interactions. Trials evaluating the efficacy of analgesics have often excluded elderly patients and universally excluded frail patients; therefore, the true efficacy and side-effect profiles in these population groups are largely unknown, especially for long-term use. A stepwise approach is recommended to managing pain, commencing with paracetamol and adding on opioids when needed to manage pain. However, because of the short duration of clinical trials, exclusion of frail patients, and minimal inclusion of elderly patients, the decision as to which opioid should be added on to paracetamol is a difficult one. This article reviews the evidence surrounding a newer opioid, tapentadol. Tapentadol acts on both the mu receptors and on neuronal reuptake of noradrenaline, and has no significant analgesically active metabolites, which theoretically presents some advantages, particularly in comparison with tramadol. However, the evidence to support tapentadol is weak and the trials were often methodologically poor and sponsored almost universally by the drug company. Currently, there is insufficient evidence to support the use of tapentadol over other opioids, which have been on the market longer, are less expensive, and have better established safety profiles. As a first-line agent after the failure of paracetamol alone, morphine, oxycodone, fentanyl, or buprenorphine are still the preferred evidence-based choices for add-on opioid therapy for elderly or frail patients.
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Pham TC, Fudin J, Raffa RB. Is levorphanol a better option than methadone? PAIN MEDICINE 2015; 16:1673-9. [PMID: 26307179 DOI: 10.1111/pme.12795] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Methadone has been a stalwart pharmacologic option for the management of opioid drug dependence for many years. It substitutes for opioid agonists and possesses certain pharmacokinetic properties that confer characteristics preferable to those of other opioids for this application. Methadone is likewise used as an option for the treatment of pain, particularly chronic pain. It has a spectrum of pharmacodynamic activity, including contributions from non-opioid components, that translates to its specific clinical attributes as an analgesic. Unfortunately, basic science studies and accumulated clinical experience with methadone have revealed some undesirable, and even worrisome, features, including issues of safety. The benefit/risk ratio of methadone might be acceptable if there was no better alternative, but neither its pharmacokinetic nor pharmacodynamic properties are unique to methadone. OBJECTIVE We review the basic and clinical pharmacology of methadone and suggest that levorphanol should receive attention as a possible alternative. CONCLUSION Unlike methadone, levorphanol is a more potent NMDA antagonist, possesses a higher affinity for DOR and KOR, has a shorter plasma half-life yet longer duration of action, has no CYP450 interactions or QTc prolongation risk, can be a viable option in the elderly, palliative care, and SCI patients, requires little to no need for co-administration of adjuvant analgesics, and has potentially a lower risk of drug-related Emergency Department visits compared to other opioids.
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Affiliation(s)
- Thien C Pham
- PGY2 Pain and Palliative Care Pharmacy Residency, Stratton VA Medical Center, Albany, New York, USA
| | - Jeffrey Fudin
- Western New England University College of Pharmacy, Springfield, Massachusetts, USA.,School of Pharmacy, University of Connecticut, Storrs, Connecticut, USA.,Clinical Pharmacy Specialist in Pain Management, Stratton VA Medical Center, Albany, New York, USA
| | - Robert B Raffa
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA
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Wilson E, Morbey H, Brown J, Payne S, Seale C, Seymour J. Administering anticipatory medications in end-of-life care: a qualitative study of nursing practice in the community and in nursing homes. Palliat Med 2015; 29:60-70. [PMID: 25070861 PMCID: PMC4266693 DOI: 10.1177/0269216314543042] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the United Kingdom, an approach to improving end-of-life care has been the introduction of 'just in case' or 'anticipatory' medications. Nurses are often responsible for deciding when to use anticipatory medications, but little is known about their experiences. AIM To examine nurses' decisions, aims and concerns when using anticipatory medications. DESIGN An ethnographic study in two UK regions, using observations and interviews with nurses working in community and nursing home teams (n = 8). FINDINGS Observations (n = 83) and interviews (n = 61) with community nurses. Nurses identified four 'conditions' that needed to be established before they implemented anticipatory medications: (1) irreversibility; (2) inability to take oral medication; (3) where the patient was able, they should consent and (4) decision had to be independent of demands or requests from patient's relatives. By using anticipation medications, nurses sought to enable patients to be 'comfortable and settled' by provision of gradual relief of symptoms at the lowest dose possible. They aimed to respond quickly to needs, seeking to avoid hospital admission or medical call-out, while adhering to local prescribing policies. Worries included distinguishing between pain and agitation, balancing risks of under- and over-medication and the possibility of hastening death. CONCLUSION Nurses take a leading role in the administration of anticipatory medications. Nurses apply consideration and caution to the administration of anticipatory medications but some experience emotional burden. Education, training and experience played a role in the nurses' confidence and should continue to be central to efforts to improving the quality of palliative care in the community and nursing homes.
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Affiliation(s)
- Eleanor Wilson
- School of Health Sciences, University of Nottingham, Queens Medical Centre, Medical School, Nottingham, UK
| | - Hazel Morbey
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Jayne Brown
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Sheila Payne
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Clive Seale
- Sociology and Communications, Brunel University, London, UK
| | - Jane Seymour
- School of Health Sciences, University of Nottingham, Queens Medical Centre, Medical School, Nottingham, UK
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Altarifi AA, Rice KC, Negus SS. Effects of μ-opioid receptor agonists in assays of acute pain-stimulated and pain-depressed behavior in male rats: role of μ-agonist efficacy and noxious stimulus intensity. J Pharmacol Exp Ther 2014; 352:208-17. [PMID: 25406170 DOI: 10.1124/jpet.114.219873] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Pain is associated with stimulation of some behaviors and depression of others, and μ-opioid receptor agonists are among the most widely used analgesics. This study used parallel assays of pain-stimulated and pain-depressed behavior in male Sprague-Dawley rats to compare antinociception profiles for six μ-agonists that varied in efficacy at μ-opioid receptors (from highest to lowest: methadone, fentanyl, morphine, hydrocodone, buprenorphine, and nalbuphine). Intraperitoneal injection of diluted lactic acid served as an acute noxious stimulus to either stimulate stretching or depress operant responding maintained by electrical stimulation in an intracranial self-stimulation (ICSS). All μ-agonists blocked both stimulation of stretching and depression of ICSS produced by 1.8% lactic acid. The high-efficacy agonists methadone and fentanyl were more potent at blocking acid-induced depression of ICSS than acid-stimulated stretching, whereas lower-efficacy agonists displayed similar potency across assays. All μ-agonists except morphine also facilitated ICSS in the absence of the noxious stimulus at doses similar to those that blocked acid-induced depression of ICSS. The potency of the low-efficacy μ-agonist nalbuphine, but not the high-efficacy μ-agonist methadone, to block acid-induced depression of ICSS was significantly reduced by increasing the intensity of the noxious stimulus to 5.6% acid. These results demonstrate sensitivity of acid-induced depression of ICSS to a range of clinically effective μ-opioid analgesics and reveal distinctions between opioids based on efficacy at the μ-receptor. These results also support the use of parallel assays of pain-stimulated and -depressed behaviors to evaluate analgesic efficacy of candidate drugs.
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Affiliation(s)
- Ahmad A Altarifi
- Department of Pharmacology, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan (A.A.A.); Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia (A.A.A., S.S.N.); and Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - Kenner C Rice
- Department of Pharmacology, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan (A.A.A.); Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia (A.A.A., S.S.N.); and Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
| | - S Stevens Negus
- Department of Pharmacology, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan (A.A.A.); Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia (A.A.A., S.S.N.); and Chemical Biology Research Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland (K.C.R.)
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Szałek E, Karbownik A, Murawa D, Połom K, Urbaniak B, Grabowski T, Wolc A, Więckiewicz A, Grześkowiak E, Kokot ZJ, Murawa P, Burchardt P, Cieśla S. The pharmacokinetics of the effervescent vs. conventional tramadol/paracetamol fixed-dose combination tablet in patients after total gastric resection. Pharmacol Rep 2014; 66:159-64. [PMID: 24905322 DOI: 10.1016/j.pharep.2013.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 05/26/2013] [Accepted: 06/13/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Tramadol/paracetamol is a fixed-dose combination prescribed for the relief of moderate to severe pain. The combination acts synergistically and guarantees the rapid onset of paracetamol and the prolonged analgesic effect of tramadol with good tolerability. These drugs are often used in various formulations in the treatment of patients with postoperative pain, e.g. after stomach resection. Gastrectomy leads to pathophysiological changes within the alimentary tract, which may affect the process of drug absorption. The aim of the research was an analysis of the pharmacokinetics of tramadol/paracetamol from effervescent and conventional tablets in patients after total gastrectomy. METHODS The research was carried out on patients after gastrectomy with Roux-en-Y reconstruction. The patients received two tramadol/paracetamol fixed-dose combination tablets in a single orally administered dose of 75/650 mg (2 × 37.5/325 mg). The patients were subjected to one of the two study drug group with: I. effervescent tablet (ET) (n = 14; mean [SD] age, 63.4 [10.1] years; weight, 75.5 [15.3]kg; and BMI, 26.0 [4.6]kg/m(2)) and II. conventional tablet (CT) (n = 12; mean [SD] age, 66.8 [7.7] years; weight, 79.8 [17.8]kg; and BMI, 27.4 [5.3]kg/m(2)). Blood samples were collected within 10 h after the drug administration. The plasma concentrations of tramadol and paracetamol were measured with validated HPLC (high-performance liquid chromatography) method with UV detection. RESULTS The comparison of the paracetamol and tramadol C(max) ratio for the ET group with that of the CT group gave ratios of 1.16 [90% confidence interval (CI) 1.06, 1.27] and 0.86 (90% CI 0.72, 1.02), respectively. The comparison of the paracetamol and tramadol AUC(0-t) ratio for the ET group with that of the CT group showed ratios of 0.99 (90% CI 0.88, 1.10) and 1.00 (90% CI 0.82, 1.22), respectively. The comparison of the difference for the effervescent and conventional formulation gave an estimated decrease in t(max) of 0.5 h for paracetamol and 0.13 h for tramadol. CONCLUSIONS In view of the changes in the pharmacokinetics of paracetamol and tramadol in the patients after gastric resection for both formulations compared the conventional tablet seems to be more appropriate due to the comparable rate of absorption of both substances, higher concentrations of tramadol and comparable exposure to paracetamol.
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Affiliation(s)
- Edyta Szałek
- Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences Poznań, Poland.
| | - Agnieszka Karbownik
- Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences Poznań, Poland
| | - Dawid Murawa
- 1st Department of Surgical Oncology and General Surgery Department, Wielkopolska Cancer Centre, Poznań, Poland
| | - Karol Połom
- 1st Department of Surgical Oncology and General Surgery Department, Wielkopolska Cancer Centre, Poznań, Poland
| | - Bartosz Urbaniak
- Department of Inorganic and Analytical Chemistry, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | | | - Anna Wolc
- Department of Animal Science, Iowa State University, IA, USA
| | - Aleksandra Więckiewicz
- Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences Poznań, Poland
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences Poznań, Poland
| | - Zenon J Kokot
- Department of Inorganic and Analytical Chemistry, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Paweł Murawa
- 1st Department of Surgical Oncology and General Surgery Department, Wielkopolska Cancer Centre, Poznań, Poland; Cancer Pathology Department, Clinic of Oncology, University of Medical Sciences, Poznań, Poland
| | - Paweł Burchardt
- Division of Cardiology-Intensive Care, University of Medical Sciences, Poznań, Poland
| | - Sławomir Cieśla
- Department of General Surgery, Leszno Regional Hospital, Leszno, Poland
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Neto JOB, Machado MDT, de Almeida Correa M, Scomparim HA, Posso IP, Ashmawi HA. Methadone patient-controlled analgesia for postoperative pain: a randomized, controlled, double-blind study. J Anesth 2014; 28:505-10. [PMID: 24445560 DOI: 10.1007/s00540-013-1785-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/28/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE Postoperative pain is an important health-care issue. Patient-controlled analgesia (PCA) is considered the gold standard for systemic postoperative pain treatment. Methadone PCA is used for patients with chronic pain and those in the palliative care setting. However, its efficacy as a first-line drug for acute postoperative pain is unknown. This study evaluated the use of postoperative methadone PCA after total hip arthroplasty (THA) compared with morphine PCA. METHODS This was a randomized, double-blind, controlled, parallel-group study. Patients were randomized into two groups: group methadone--methadone PCA, and group morphine--morphine PCA, for postoperative analgesia. Drugs were delivered through PCA pumps throughout the first 24 h after surgery (T1:6, T2:12, T3:18, T4:24 h). RESULTS Opioid consumption in 24 h was significantly lower for group methadone than for group morphine. Group methadone patients experienced significantly less pain than group morphine at rest. Pain after movement was significantly lower in group methadone at T1 and T3 and marginally lower at T2 and T4. Adverse events more frequently reported were sleepiness, nausea, and vomiting, but no statistical difference between groups was found. CONCLUSION This study demonstrated that methadone PCA prompted less opioid consumption and lower pain scores at rest and at motion in comparison with morphine PCA as postoperative analgesia after THA.
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Ruiz M, Armstrong M, Ogboukiri T, Anwar D. Patterns of pain medication use during last months of life in HIV-infected populations: the experience of an academic outpatient clinic. Am J Hosp Palliat Care 2013; 31:793-6. [PMID: 24031078 DOI: 10.1177/1049909113503541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION This article describes the patterns of use of pain medicines of HIV-infected patients during last months of life in an HIV university-affiliated outpatient clinic. METHODS We retrospectively reviewed our databases and identified patients who died over the last 12 months in our clinic. Demographic, clinical, and laboratory information were abstracted. RESULTS A total of 41 patients died in our HIV outpatient clinic in a period of 12 months. Opioid analgesics were prescribed for 21 (51%) patients, with 10 (48%) of these patients prescribed short-acting opioid analgesics alone, In all, 11 patients (52%) were on a short-acting and long-acting opioid combination, and 30 (73%) patients experienced pain that was not adequately controlled. DISCUSSION Pain control during the last months of life for this population appears to be suboptimal. Better strategies are needed.
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Affiliation(s)
- Marco Ruiz
- Department of Medicine, Section of Geriatric Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Megan Armstrong
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tina Ogboukiri
- Department of Pharmacy, Xavier University, New Orleans, LA, USA
| | - Dominique Anwar
- Department of Medicine, Tulane School of Medicine, New Orleans, LA, USA
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Effects of combined application of muscle relaxants and celecoxib administration after total knee arthroplasty (TKA) on early recovery: a randomized, double-blind, controlled study. J Arthroplasty 2013; 28:1301-5. [PMID: 23561916 DOI: 10.1016/j.arth.2012.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 08/30/2012] [Accepted: 10/01/2012] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate the effectiveness of application of muscle relaxants and celecoxib in early recovery after total knee arthroplasty (TKA). One hundred and fifty patients were randomized 1:1:1 to receive either both of muscle relaxants and celecoxib or muscle relaxants alone or placebo for 2 weeks (50 patients in each group). VAS pain scores as primary efficacy, active range of motion, morphine consumption, blood loss, and postoperative complications including postoperative nausea and vomiting (PONV), extremities myasthenia and deep vein thrombosis (DVT) were determined postoperatively. Group A improved better with reduced VAS pain scores compared with another two groups. These results demonstrated that application of muscle relaxants and celecoxib into patients undergoing TKA for 2 weeks postoperative consequently improved their convalescence.
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Thomas SA. Effective pain management of older adult hospice patients with cancer. HOME HEALTHCARE NURSE 2013; 31:242-247. [PMID: 23652974 DOI: 10.1097/nhh.0b013e31828eb4ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pain is subjective and a unique and individual experience. For those involved in the care of hospice patients, pain management can be challenging and is not always effectively managed. This case study explores an older adult cancer patient's pain experience at the end of her life with implementation of pain management strategies from hospice.
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Affiliation(s)
- Scott A Thomas
- Department of Emergency Medicine, University of Cincinnati Physicians, Cincinnati, OH 45255, USA.
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Heppner HJ, Christ M, Gosch M, Mühlberg W, Bahrmann P, Bertsch T, Sieber C, Singler K. Polypharmacy in the elderly from the clinical toxicologist perspective. Z Gerontol Geriatr 2013; 45:473-8. [PMID: 22915001 DOI: 10.1007/s00391-012-0383-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Polypharmacy is closely associated with multimorbidity in the elderly and can lead to problems and drug interactions. AIM This study assessed polypharmacy in the elderly, tracking inquiries to the Poison Information Centre Nuremberg (PICN) and patients needing toxicological intensive care therapy. METHODS From 2006-2009, all PICN inquiries involving individuals > 70 years were tracked, as were cases at the Toxicological Intensive Care Unit (T-ICU) regarding adverse drug reactions (ADRs) and drug poisoning. RESULTS Of 11,683 PICN calls about pharmaceuticals, 175 (1.5%) were from people > 70 years; 156 (4.8%) of 3,272 T-ICU patients were > 70 years. Calls about psychopharmaceuticals (46.9%) and analgesics (25.7%) were most frequent. Among the T-ICU patients, psychopharmaceuticals like sedatives and hypnotics were frequently involved (20.5%), as were tricyclic antidepressants (17.9%) and analgesics (29.5%). Ethanol was co-ingested by 18.3%. CONCLUSION Population-specific poison prevention strategies are needed to reduce toxic exposures. Such strategies could include pharmacist intervention, improved prescriber communication and education regarding the geriatric population, and computerized drug databases.
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Affiliation(s)
- H J Heppner
- Department of Emergency and Intensive Care Medicine, Klinikum Nuremberg, Prof.-E.-Nathan-Str. 1, 90419, Nuremberg, Germany.
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Brouwers JRBJ, van Ojik AL, van Roon EN, Jansen PAF. Authors’ Reply to Pergolizzi: “Treatment of Chronic Pain in Older People: Evidence-Based Choice of Strong-Acting Opioids”. Drugs Aging 2012. [DOI: 10.1007/s40266-012-0028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Take an individualized approach when managing pain in the elderly at the end of life. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.1007/bf03262120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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&NA;. Take an individualized approach when managing pain in the elderly at the end of life. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.2165/11209790-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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