Acute intoxication following massive bupropion sniffing: A case report

Bupropion intranasal misuse potential should be considered in the suspect of sympathomimetic syndrome for illicit drug or medication intoxication. A 31-year-old man was admitted for intranasal misuse of 30 crushed tablets of bupropion with adrenergic mild presentation. Lorazepam infusion was started with complete clinical resolution. Further forensic investigations detected a bupropion serum and urine concentration levels at 18 hours from intake of 1905.26 ng/mL and 2001.57 ng/mL, respectively. This case of intranasal bupropion misuse shared only some features with oral overdose, despite a plasma concentration five times higher than the lowest toxic level. Nasal bupropion snorting in chronic users could have lower toxicity compared to other snorted stimulants but symptomatic treatment remains the gold standard for preventing complications. Bupropion misuse might rapidly become a concerning issue and monitoring by healthcare professionals is needed.

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Breakthrough Pain in Cancer Patients— Pharmacologic Symptomatic Treatment

Oncology & Hematology Review (US) ◽

10.17925/ohr.2011.07.1.17 ◽

2011 ◽

Vol 07 (01) ◽

pp. 17

Author(s):

Marco Pappagallo ◽

Keyword(s):

Cancer Patients ◽

Gold Standard ◽

Breakthrough Pain ◽

Symptomatic Treatment ◽

Persistent Pain ◽

Standard Approach ◽

Routes Of Administration ◽

No Gold Standard ◽

Current Guidelines

Breakthrough pain is experienced by many cancer patients who are being treated with opioids for the management of chronic persistent pain. There is currently no ‘gold standard’ approach for the pharmacologic symptomatic treatment of breakthrough pain but proposed strategies include the implementation of primary therapies (e.g. chemotherapy, radiotherapy, and surgery) for the underlying cause of the pain; optimization of scheduled analgesia; use of adjuvants; and specific supplemental analgesia for breakthrough pain (the most common pharmacologic strategy). Individualization of treatment is important and a combination of these strategies may be required. In this article, pharmacotherapeutic approaches to managing breakthrough pain are discussed, including different routes of administration and newer opioid formulations. In addition, the current guidelines for managing breakthrough pain are examined.

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Selenium in human urine: concentration levels and medical implications

Clinica Chimica Acta ◽

10.1016/0009-8981(84)90282-1 ◽

1984 ◽

Vol 136 (2-3) ◽

pp. 107-120 ◽

Cited By ~ 59

Author(s):

H.J. Robberecht ◽

H.A. Deelstra

Keyword(s):

Human Urine ◽

Urine Concentration ◽

Concentration Levels

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Substance Use and Homelessness: An Inner-City Group Discussion on Marginalization in Healthcare Practices

University of Ottawa Journal of Medicine ◽

10.18192/uojm.v9i2.4498 ◽

2019 ◽

Vol 9 (2) ◽

pp. 24-28

Author(s):

Nardin Hanna ◽

Breton Burke

Keyword(s):

Substance Use ◽

Inner City ◽

Drug Users ◽

Healthcare Professionals ◽

Illicit Drug ◽

Group Discussion ◽

Discussion Group ◽

Harm Reduction Strategy ◽

City Group ◽

Qualitative Discussion

Ottawa Inner City Health’s Managed Alcohol Program administers alcohol to its patients who are struggling with alcohol dependency. Although it may seem like a paradoxical approach, this program is a harm-reduction strategy intended to help some of the most marginalized peoples in Ottawa. A qualitative discussion group composed of individuals utilizing various substance use support programs in Ottawa comments on various strategies to reduce stigma against inner-city individuals, support illicit drug users, and prevent overdoses. Healthcare professionals are well positioned to ensure these strategies are put to action by advocating for patients with substance use issues and promoting equitable healthcare.

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Magnesium serum and urine concentration in patients with acute and chronic pulmonary disease

Jugoslovenska medicinska biohemija ◽

10.2298/jmh0402155n ◽

2004 ◽

Vol 23 (2) ◽

pp. 155-160 ◽

Cited By ~ 1

Author(s):

Ljudmila Nagorni-Obradovic ◽

Svetlana Ignjatovic ◽

Vesna Petrovic ◽

Marija Mitic-Milikic

Keyword(s):

Pulmonary Disease ◽

Urine Concentration ◽

Pulmonary Diseases ◽

Magnesium Concentration ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

End Of Treatment ◽

Chronic Pulmonary Diseases ◽

Serum And Urine

In this study we determined magnesium concentration in serum and in 24-hour urine, at the start (To) and at the end of treatment (T1), in 56 patients with acute pulmonary disease (B1) and in 58 patients with chronic obstructive pulmonary disease - COPD (B2). In group B1 there was disbalance of Mg in serum in 14-25% patients at the start of treatment (To) which decreased significantly at the end of treatment (T1) and persisted in 4-7.1% patients (p < 0.05). In group B2 distribution of normal, decreased and increased values of Mg in serum was similar in patients in period To and T1 (p > 0.05). In group B1, 9 (16.1%) patients had hypomagnesemia at the start of treatment (To), which was accompanied by increased concentration of Mg in 24-hour urine of only 4 (7.2%) patients. There is a possibility that there was extrarenal elimination of Mg in patients with acute pulmonary disease or there was some kind of transcellular distribution. In group B2 in period To, there was proportional ratio between hypomagnesemia (12-20.7% patients) and increased concentration of Mg in 24-hour urine (20 -34.5% patients). This could be because of renal loss. Simultaneous determination and follow up of magnesium in serum and in 24-hour urine can give us reliable information about homeostasis of this electrolyte in acute and chronic pulmonary diseases.

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Elevation in the Serum and Urine Concentration of Injury-Related Molecules After the Formation of Deep Tissue Injury in a Rat Spinal Cord Injury Pressure Ulcer Model

PM&R ◽

10.1016/j.pmrj.2010.08.002 ◽

2010 ◽

Vol 2 (11) ◽

pp. 1063-1065 ◽

Cited By ~ 7

Author(s):

Mohsen Makhsous ◽

Fang Lin ◽

Atek Pandya ◽

Mauli S. Pandya ◽

Christopher C. Chadwick

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Tissue Injury ◽

Urine Concentration ◽

Rat Spinal Cord ◽

Deep Tissue ◽

Deep Tissue Injury ◽

Cord Injury ◽

Ulcer Model ◽

Serum And Urine

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Comparison of Two Commercially Available Fentanyl Screening Immunoassays for Clinical Use

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfaa048 ◽

2020 ◽

Vol 5 (6) ◽

pp. 1277-1286 ◽

Cited By ~ 1

Author(s):

Melissa M Budelier ◽

Caroline E Franks ◽

Nicole Logsdon ◽

Paul J Jannetto ◽

Mitchell G Scott ◽

...

Keyword(s):

Gold Standard ◽

Open Channel ◽

Illicit Drug ◽

Cross Reactivity ◽

Limited Data ◽

Chromatography Tandem Mass Spectrometry ◽

Liquid Chromatography Tandem Mass ◽

Fentanyl Analogs ◽

Overdose Deaths ◽

Roche Cobas

Abstract Background Fentanyl is a synthetic opioid associated with illicit drug use and overdose deaths. The SEFRIA Immunalysis (IAL) and ARK fentanyl assays are both FDA-cleared, open channel immunoassays for fentanyl detection in urine. However, limited data are available in the literature comparing these assays. The objective of this study was to perform a direct comparison of these two fentanyl immunoassays. Methods IAL and ARK fentanyl immunoassays were performed on a Roche Cobas e602 automated chemistry analyzer. Repeatability and total imprecision were compared by diluting fentanyl into urine at concentrations above, below, and at the manufacturers’ cutoffs of 1.0 ng/mL. Cross-reactivity was assessed for norfentanyl and the fentanyl analogs acetylfentanyl, acrylfentanyl, and furanylfentanyl. Concordance was assessed in 90 patient samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS) as the gold standard. Results Repeatability varied from 11.4%–17.8% on the IAL assay and 2.8%–5.5% on the ARK assay. Total imprecision was 18.9%–40.7% on the IAL assay and 2.9%–6.4% on the ARK assay. Both assays cross-reacted with acetylfentanyl (∼100%), acrylfentanyl (∼100%), and furanylfentanyl (∼20%), but only the ARK assay cross-reacted with norfentanyl (∼3%). An admixture of 0.5 ng/mL fentanyl and 6 ng/mL norfentanyl produced a positive result on the ARK assay. Total concordance between IAL and ARK for 90 tested patient samples was 93% (kappa = 0.85). Relative to LC-MS/MS, the IAL assay had a concordance of 90% (kappa = 0.79) and the ARK assay had a concordance of 94% (kappa = 0.88). Including norfentanyl in the LC-MS/MS confirmation increased the concordance of the ARK to 96% (kappa = 0.90). Conclusions The ARK assay recognized the metabolite norfentanyl, demonstrated superior precision, and had better concordance with LC-MS/MS compared to the IAL assay.

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Population pharmacokinetics of high-dose methotrexate in Japanese adult patients with malignancies: a concurrent analysis of the serum and urine concentration data

Journal of Clinical Pharmacy and Therapeutics ◽

10.1111/j.1365-2710.2008.00966.x ◽

2008 ◽

Vol 33 (6) ◽

pp. 677-684 ◽

Cited By ~ 24

Author(s):

K. Fukuhara ◽

K. Ikawa ◽

N. Morikawa ◽

K. Kumagai

Keyword(s):

Population Pharmacokinetics ◽

Urine Concentration ◽

Adult Patients ◽

High Dose ◽

High Dose Methotrexate ◽

Japanese Adult ◽

Concentration Data ◽

Dose Methotrexate ◽

Concurrent Analysis ◽

Serum And Urine

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Gold Standard of Symptomatic treatment in Parkinson disease: Carbidopa / Levodopa

NeuroPharmac Journal ◽

10.37881/1.331 ◽

2018 ◽

pp. 63-68 ◽

Cited By ~ 1

Author(s):

Aslam Pathan ◽

Abdulrahman Alshahrani

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Adverse Effects ◽

Gold Standard ◽

Signs And Symptoms ◽

Symptomatic Treatment ◽

Short Term ◽

Neurologic Disorders ◽

Pharmacological Data

Parkinson's disease (PD) is one of the most common neurologic disorders, affecting approximately 1% of individuals older than 60 years and causing progressive disability that can be slowed but not halted, by treatment. The goal of the medical management of Parkinson's disease is to provide control of signs and symptoms for as long as possible while minimizing adverse effects. Levodopa coupled with a peripheral decarboxylase inhibitor (PDI), such as carbidopa, remains the gold standard of symptomatic treatment of motor features of Parkinson's disease. It provides the greatest antiparkinsonian benefit with the fewest adverse effects in the short term. However, its long-term use is associated with the development of fluctuations and dyskinesias. This review article is written to summarize the clinical and pharmacological data of carbidopa and levodopa which will be helpful to neurologists and physicians.

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