Current clinical pharmacology
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Breakthrough pain (BTP) is a transitory exacerbation of pain that occurs on a background of otherwise controlled pain. It is associated in conjunction with severe chronic pain and may result in impaired physical and psychological functioning, reduced effectiveness to opioids and also, increased financial burden. It manifests commonly in malignant pain, as manifested by well managed round the clock regular opioid medication but associated with intermittent sharp pain symptoms that are not controlled by the regular medication. ⋯ However with recent advances in drug delivery systems, transmucosal and buccal routes have gained popularity. Pharmacokinetic studies have demonstrated a high early systemic exposure to opioids well over their therapeutic dose range resulting in management of the breakthrough pain. This article proposes to review the evidence base on the effectiveness of these novel opioid delivery systems in managing the breakthrough pain.
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The incidence and potential for serious adverse drug reactions (SADRs) in anesthesia are high due to the narrow therapeutic indices of anesthetic and analgesic drugs and high interindividual variability in drug responses. Genetic factors contribute to a majority of these SADRs. Pharmacogenetics (PG), the study of genetic effects on drug action, is strongly related to the field of anesthesia; historically, succinylcholine apnea and malignant hyperthermia were among the first PG disorders reported. ⋯ Epigenetics and functional genomics are also discussed. The article also addresses various critical deficits in our current knowledge of PG related to anesthesia that account for the minimal clinical translation of the findings in this area in the present time. The review concludes that in addition to enhanced data generation facilitated by rapidly evolving genetic techniques, robust clinical study designs in a large sample and sound statistical analyses are essential prerequisites for the successful clinical implementation of research findings to individual perioperative care for every patient.