scholarly journals Long-Term Intravenous Ketamine for Analgesia in a Child with Severe Chronic Intestinal Graft versus Host Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Jennifer Busse ◽  
Leroy Phillips ◽  
William Schechter
Keyword(s):  
Abdominal Pain ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Pediatric Patients ◽  
Hemorrhagic Cystitis ◽  
Graft Versus Host ◽  
Intestinal Gvhd ◽  
High Doses ◽  
Intravenous Ketamine

Ketamine is reported to be an effective adjuvant to opioids in the treatment of refractory cancer pain; however, the use of high doses of ketamine for extended periods in pediatric patients has not been described. We present a five-year-old male with grade IV intestinal GVHD whose abdominal pain required both hydromorphone and ketamine for a period of over four months. There was no evidence of hepatotoxicity, hemorrhagic cystitis, or other adverse effects. Possible withdrawal symptoms were mild and were readily mitigated by gradually weaning ketamine.

scholarly journals Acute Abdomen in a Patient with Cancer Pain on Oxycodone

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Naomi Kishine ◽  
Atsunobu Tsunoda ◽  
Seiji Kishimoto ◽  
Tomohisa Shoko
Keyword(s):  
Abdominal Pain ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Acute Abdomen ◽  
Pain Therapy ◽  
Acute Abdominal Pain ◽  
Colonic Obstruction ◽  
Abdominal Distension ◽  
Abrupt Increase ◽  
Cancer Pain Therapy

Opioids are a mainstay of treatment for moderate to severe cancer pain. At present, oxycodone has fewer adverse effects compared to morphine and is widely used for cancer pain therapy. The adverse effects of oxycodone are similar to morphine and include constipation, nausea, and sedation. However, acute abdominal pain is rarely seen. Here, we describe a cancer patient presenting with acute abdomen with stercoral diarrhea. A 54-year-old man with squamous cell carcinoma of the external auditory canal had been taking oxycodone for pain relief. The patient had taken oxycodone for several months and had never complained of either diarrhea or constipation. After an increase in the dosage of oxycodone, he complained of abdominal distension and constipation. After being administered a laxative, he complained of diarrhea and severe abdominal pain. He visited the emergency department and was diagnosed with acute colonic obstruction caused by severe constipation. He self-medicated with oxycodone at dosages of up to 180 mg/day, and this abrupt increase of oxycodone caused stercoral diarrhea. Finally, total blockage of stool developed, resulting in acute abdomen.

Chronic non-cancer pain and the long-term efficacy and safety of opioids: Some blind men and an elephant?

2012 ◽  
Vol 3 (1) ◽  
pp. 5-13 ◽  
Author(s):  
C. Peter ◽  
N. Watson
Keyword(s):  
Quality Of Life ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Functional Status ◽  
Efficacy And Safety ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

AbstractBackgroundThe use of opioids for chronic non-cancer pain (CNCP) remains very controversial. There are a number of randomized controlled trials (RCTs) showing efficacy and safety in the short-term, but long-term data are limited.MethodsThis article contains 10 case reports (followed to 2011) that were selected from a survey of 84 patients with intractable CNCP treated with opioids and followed every 3 months now for a median of 10 years. The previous published survey of this group reported outcomes of pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life (HRQL), immune status and sexual function. The outcome measures for that study included a numerical rating scale (NRS) for pain, Hospital Anxiety and Depression Scale (HADS), the Brief Pain Inventory Interference Scale (BPI-I), the Pain Disability Index (PDI), and for Health Related Quality of Life (HRQL) the Short Form Health Survey 12 version 2 (SF12v2). These selected patient reports were chosen to illustrate some important aspects of the diagnostic categories of CNCP, the opioids and doses used, particular issues (concurrent addiction history, bipolar disorder, and combination therapy), disease-specific and other outcomes (pain severity and relief, adverse effects, mood, function) and duration of follow-up with complex pain problems.ResultsOpioids were found to be safe and effective in the long-term for these particular patients, as well as in the larger group from which they originate. Most patients in the total sample reported 50% or greater relief and a moderate improvement in disability. Scores for functional status and HRQL were not severely affected (PDI and BPI-I ratings moderate or less and SF12v2 slightly below normative values for age). Problematic use, tolerance, and serious adverse effects including constipation were not major issues.ConclusionThese 10 reports of patients with intractable CNCP treated with opioids with some success over many years put a face on some of the participants in the larger survey of 84 suggesting that this approach is effective and safe for some patients over many years.ImplicationsThese data may not be generalizable to a larger population of patients with CNCP because of the probable selection of patients who benefit and who do not have intolerable adverse effects.

scholarly journals How to avoid statin hepatotoxicity in patients with obesity and liver disease? Focus on the combination of ursodeoxycholic acid and atorvastatin

2012 ◽  
Vol 11 (6) ◽  
pp. 81-84
Author(s):  
O. N. Korneeva ◽  
O. M. Drapkina
Keyword(s):  
Liver Disease ◽  
Adverse Effects ◽  
Ursodeoxycholic Acid ◽  
Hepatic Function ◽  
Clinical Group ◽  
Clinical Effects ◽  
Obese Patients ◽  
Effective Doses ◽  
High Doses

Obese patients demonstrate the combination of dyslipidemia (DLP) and elevated transaminase levels, as a manifestation of non-alcohol fatty liver disease (NAFLD). Therefore, statins should be administered with care in this clinical group. In the real-world clinical practice, obese patients with high cardiovascular risk and concomitant NAFLD often receive low, inadequately effective doses of statins, due to the fear of their adverse effects on the hepatic function. An alternative method of DLP treatment is a combination of statins with ursodeoxycholic acid (UDCA). The need for a long-term combination treatment with statins and UDCA stresses the importance of the problem of drug interaction and the mechanisms of drug metabolism. Even high doses of atorvastatin are safe and well tolerated. The most severe adverse effects – myopathy and rhabdomyolysis – are very rare. Currently, there is no available evidence of adverse clinical effects of the combination of UDCA and atorvastatin. Presented results emphasise the need for a wider use of new therapeutic strategies in patients with DLP, obesity, and NAFLD. The combination of UDCA and statins is safe and effective. It facilitates not only the achievement of target lipid levels, but also the improvement in the hepatic function.

scholarly journals Systematic review on long-term adverse effects of inhaled corticosteroids in the treatment of COPD

2021 ◽  
Vol 30 (160) ◽  
pp. 210075
Author(s):  
Marc Miravitlles ◽  
Ariadna Auladell-Rispau ◽  
Mònica Monteagudo ◽  
Juan Carlos Vázquez-Niebla ◽  
Jibril Mohammed ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Inhaled Corticosteroids ◽  
Oral Candidiasis ◽  
Strong Association ◽  
Significant Proportion ◽  
High Doses ◽  
Study Designs ◽  
Nested Case Control

Inhaled corticosteroids (ICSs) are indicated for the prevention of exacerbations in COPD; however, a significant proportion of patients at low risk of exacerbations are treated with ICSs. We conducted a systematic review including a diversity of types of study designs and safety outcomes with the objective of describing the risk of adverse effects associated with the long-term use of ICSs in patients with COPD.A total of 90 references corresponding to 83 studies were included, including 26 randomised clinical trials (RCTs), 33 cohort studies, and 24 nested case–control (NCC) studies. Analysis of 19 RCTs showed that exposure to ICSs for ≥1 year increased the risk of pneumonia by 41% (risk ratio 1.41, 95% CI 1.23–1.61). Additionally, cohort and NCC studies showed an association between ICSs and risk of tuberculosis and mycobacterial disease. There was a strong association between ICS use and local disorders such as oral candidiasis and dysphonia. The association between ICSs and the risk of diabetes and fractures was less clear and appeared significant only at high doses of ICSs.Since most patients with COPD are elderly and with frequent comorbidities, an adequate risk–benefit balance is crucial for the indication of ICSs.

scholarly journals Effectiveness of Long-Term Opioid Therapy for Chronic Non-Cancer Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. E133-E156 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Functional Status ◽  
Outcome Measures ◽  
Opioid Therapy ◽  
Review Of The Literature ◽  
Chronic Opioid Therapy ◽  
Comprehensive Review

Background: Opioids have been utilized for thousands of years to treat pain and their use continues to escalate. It is estimated that 90% of the patients who present to pain centers and receive treatment in such facilities are on opioids. However, in contrast to increasing opioid use and the lack of evidence supporting long-term effectiveness in chronic non-cancer pain, is the escalating misuse of prescription opioids, including abuse and diversion. There is also uncertainty about the incidence and clinical salience of multiple, poorly characterized adverse drug events, including endocrine dysfunction, immunosuppression, infectious disease, opioidinduced hyperalgesia, overdoses, deaths, and psychosocial and economic implications. Study Design: A comprehensive review of the literature. Objective: The objective of this comprehensive review is to evaluate the clinical effectiveness and safety of chronic opioid therapy in chronic non-cancer pain. Methods: A comprehensive review of the literature relating to chronic opioid therapy in chronic non-cancer pain. The literature was collected from various electronic and other sources. The literature that was evaluated included randomized trials, observational studies, case reports, systematic reviews, and guidelines. Outcome Measures: Pain relief was the primary outcome measure. The secondary outcome measures were functional improvement and adverse effects. Short-term effectiveness was considered to be less than 6 months; long-term effectiveness was considered to be at least one year. Results: Given the complexity and widespread nature of opioid therapy, there is a paucity of qualitative and/or quantitative literature. The available evidence is weak for pain relief combined with improvement in functional status. Only one drug, tramadol, is effective for pain relief and improvement of functional status. Limitations: This is a narrative review without application of methodologic quality assessment criteria. Even so, a paucity of literature exists concerning both controlled and observational literature for multiple drugs and multiple conditions of chronic non-cancer pain. Conclusions: This comprehensive review illustrates the lack of literature on long-term opioid therapy; thus, opioid therapy should be provided with great restraint and caution, based on the weak evidence available. Key words: Chronic non-cancer pain, opioids, opioid effectiveness, adverse effects, morphine, hydrocodone, hydromorphone, fentanyl, tramadol, methadone, oxycodone

scholarly journals Adverse effects of antioxidative vitamins

2012 ◽  
Vol 25 (2) ◽  
Author(s):  
Maciej Rutkowski ◽  
Krzysztof Grzegorczyk
Keyword(s):  
Adverse Effects ◽  
Health Effects ◽  
Toxic Effects ◽  
Medical Applications ◽  
Antioxidative Vitamins ◽  
Chemical Factors ◽  
Term Basis ◽  
High Doses ◽  
Β Carotene

AbstractHigh doses of synthetic antioxidative vitamins: A, E, C and β-carotene are often used on long-term basis in numerous preventive and therapeutic medical applications. Instead of expected health effects, the use of those vitamins may however lead to cases of hypervitaminosis and even to intoxication. The article points out main principles of safety which are to be observed during supplementation with antioxidative vitamins. Toxic effects resulting from erroneous administration of high doses of those substances on organs and systems of the organism are also discussed. Attention is drawn to interactions of antioxidative vitamins with concomitantly used drugs, as well as intensification of adverse effects caused by various exogenous chemical factors. Moreover, the article presents the evaluation of supplementation with these vitamins, which was performed in large studies.

1608: Long-Term Treatment with High Doses of Sildenafil Does Not Up-Regulate the Levels of Phosphodiesterase 5 (Pde5) in the Rat Penis

2004 ◽  
Vol 171 (4S) ◽  
pp. 424-424 ◽  
Author(s):  
Monica G. Ferrini ◽  
Eliane G. Valente ◽  
Jacob Rajfer ◽  
Nestor F. Gonzalez-Cadavid
Keyword(s):  
Term Treatment ◽  
Long Term Treatment ◽  
High Doses ◽  
Phosphodiesterase 5

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

2020 ◽  
Author(s):  
Gürkan Atay ◽  
Demet Demirkol
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Demyelinating Disease ◽  
Pediatric Intensive Care ◽  
Therapeutic Plasma Exchange ◽  
Transplantation Rejection ◽  
Access Problems ◽  
Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

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