PHARMACY CONSULTING: NEW DRUG FORMS AND NEW OPPORTUNITIES

Pain syndrome of various origins and varying intensity is the most common and leading reason for seeking medical care in the world. The main drugs for the relief of both acute and chronic pain syndrome from the 20th century to the present are non- steroidal anti-inflammatory drugs (NSAIDs). More than 30 million people worldwide receive them every day. Along with pain, other common indications for NSAIDs are fever and inflammation. All NSAIDs differ in the degree of effectiveness, form of release, speed of onset of clinical effect and dosage. That is why one of the fundamental tasks of the pharmacist, in the framework of pharmacy counseling, is to provide the patient with quality medicines and teach them how to use them rationally. With the rapid development of medical and information technologies in the modern world, the fulfillment of this task becomes more and more important, complex and responsible action. The appearance, on the pharmaceutical market innovative NSAIDs in accelerated-release dosage’s forms (for example, Ketorol® Express), makes it possible to expand the pharmacy list.

Dynamic responses of renal oxygenation at the onset of cardiopulmonary bypass in sheep and man

Introduction: The renal medulla is susceptible to hypoxia during cardiopulmonary bypass (CPB), which may contribute to the development of acute kidney injury. But the speed of onset of renal medullary hypoxia remains unknown. Methods: We continuously measured renal medullary oxygen tension (MPO2) in 24 sheep, and urinary PO2 (UPO2) as an index of MPO2 in 92 patients, before and after induction of CPB. Results: In laterally recumbent sheep with a right thoracotomy ( n = 20), even before CPB commenced MPO2 fell from (mean ± SEM) 52 ± 4 to 41 ±5 mmHg simultaneously with reduced arterial pressure (from 108 ± 5 to 88 ± 5 mmHg). In dorsally recumbent sheep with a medial sternotomy ( n = 4), MPO2 was even more severely reduced (to 12 ± 12 mmHg) before CPB. In laterally recumbent sheep in which a crystalloid prime was used ( n = 7), after commencing CPB, MPO2 fell abruptly to 24 ±6 mmHg within 20–30 minutes. MPO2 during CPB was not improved by adding donor blood to the prime ( n = 13). In patients undergoing cardiac surgery, UPO2 fell by 4 ± 1 mmHg and mean arterial pressure fell by 7 ± 1 mmHg during the 30 minutes before CPB. UPO2 then fell by a further 12 ± 2 mmHg during the first 30 minutes of CPB but remained relatively stable for the remaining 24 minutes of observation. Conclusions: Renal medullary hypoxia is an early event during CPB. It starts to develop even before CPB, presumably due to a pressure-dependent decrease in renal blood flow. Medullary hypoxia during CPB appears to be promoted by hypotension and is not ameliorated by increasing blood hemoglobin concentration.

Effects of Bupivacaine on Opioid Patient-Controlled Intrathecal Analgesia in Chronic Pain Patients Implanted with Drug Delivery Systems

Background Combining neuraxial opioids and local anesthetics in acute pain results in improved duration of analgesia and reduced dosages and adverse effects. Although commonly used in intrathecal drug delivery systems (IDDS) for chronic pain, the effectiveness of this admixture has not been examined specifically in relation to patient-controlled intrathecal analgesia (PCIA). Methods IDDS-implanted chronic noncancer pain patients receiving opioids with bupivacaine (O + B) were randomized to receive either opioids without bupivacaine (O) or O + B in a double-blind manner, at IDDS refills, for one week and then crossed over to the other solution for another week. Primary outcome measures included numeric rating scale (NRS) pain scores before and within 30 minutes after PCIA boluses. Secondary outcome measures included average NRS scores and functional outcome measures. Results Seventeen patients were enrolled, and 16 patients completed the study. There were no differences in NRS scores before and after PCIA boluses between the O and O + B conditions, though pain scores improved significantly (average decrease in NRS scores: O 1.81 ± 1.47 vs O + B 1.87 ± 1.40, P = 0.688). No differences were noted in speed of onset or duration of analgesia. Although more patients subjectively preferred the O + B treatment, the difference was not statistically significant. No differences were noted in secondary outcome measures, with the exception of global impression of change having higher scores in O compared with O + B. Conclusions Acutely removing bupivacaine from a chronic intrathecal infusion of opioids and bupivacaine in patients with chronic noncancer pain did not adversely affect PCIA effectiveness, nor did it affect speed of onset or duration of effect. These findings are divergent from those in acute pain and may have to do with study conditions and pain phenotypes.

Overview of acute oncology

Describes the common causes of spinal cord compression, the symptoms and speed of onset. Outlines immediate diagnostic and therapy options. Emphasis on the need for early diagnosis and therapy to ensure optimal outcomes in longer term.Describes the most common and dreaded of cytotoxic chemotherapy side-effects which is pancytopaenia caused by killing of bone marrow cells. Life threatening when accompanied by infection – neutropaenic sepsis. Outlines symptoms, investigations and immediate therapy guidelines.