Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2018
Prescription Drug Monitoring Programs: Relationships Among Program Awareness, Use, and State Mandates.
The inappropriate use of opioids in the United States has increased markedly and has resulted in a tragic loss of lives. To combat this problem, prescription drug monitoring programs (PDMPs) have been instituted in most states. Use of the programs is voluntary for prescribers in some states, whereas in other states it is mandatory. ⋯ Ohio pre-mandate: 64% vs. 51%; χ2 = 15.66, P < .0001; and Ohio post-mandate vs. North Carolina: 64% vs. 42%; χ2 = 12.76, P < .0001). Based on these results, mandating use may be an effective method to increase PDMP utilization.
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J Pain Palliat Care Pharmacother · Jun 2018
Randomized Controlled TrialA Prospective, Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate Intravenous Acetaminophen Versus Placebo in Patients Undergoing Robotic-Assisted Laparoscopic Prostatectomy.
Radical prostatectomy for prostate cancer is one of the most commonly performed operations in men. The objective of this study was to determine the impact of intravenous (IV) acetaminophen when added to the perioperative analgesic regimen for robotic-assisted laparoscopic prostatectomy (RALP) on hospital length of stay (LOS), postoperative pain scores, and opioid consumption. In this prospective, randomized, double-blind, placebo-controlled trial, a total of 86 patients undergoing RALP were prospectively enrolled and randomly assigned to receive either 1 g IV acetaminophen (study group; n = 43) or IV placebo (n = 43) within 15 minutes following the induction of anesthesia and prior to surgical incision. ⋯ Hospital LOS was shorter in the IV acetaminophen group compared with placebo by 32% (P = .006). Median intraoperative opioid use in the IV acetaminophen group was 42 mg morphine equivalents compared with 50 mg in placebo (P = .64) and 8 mg in both groups postoperatively (P = .16). Overall, use of perioperative IV acetaminophen decreased hospital LOS without a significant difference in PACU LOS, pain scores, or opioid use.
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J Pain Palliat Care Pharmacother · Jun 2018
Comparative StudyLaxative Use in Inpatients on Oxycodone/Naloxone Prolonged Release and Oxycodone Prolonged Release for Cancer and Non-cancer Pain.
To examine the laxative prescriptions in hospital inpatients with cancer and non-cancer pain on oxycodone compared to oxycodone plus naloxone combination. ⋯ This retrospective study of hospital inpatients with cancer and non-cancer pain found that laxative use was not reduced in those on combined oxycodone/naloxone compared to oxycodone alone, suggesting that despite the interpretations of the clinical trials in the phase IV setting, the addition of naloxone had no effect on reducing laxative use.
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J Pain Palliat Care Pharmacother · Jun 2018
Case ReportsA Treatment for Refractory High Ileostomy Output.
We present a case where the glucagon-like peptide 2 (GLP-2) analog teduglutide was used successfully to decrease high ostomy output due to short bowel syndrome in a patient not entirely dependent on parenteral nutrition. Short bowel syndrome is known to decrease quality of life and is associated with high health care costs. Although use has been limited by cost, teduglutide appears to be a treatment option for palliative care practice if patients suffer from short bowel syndrome.
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Adverse drug reactions (ADRs) have an impact on patient morbidity and mortality. Palliative care patients constitute a vulnerable population due to the complexity of their care and treatments. This study sought to identify ADRs in palliative care, assess their severity and preventability, and identify specific medications most commonly involved. ⋯ Antimicrobials, opioids, and anticoagulants were the most common causative agents. ADRs are commonly experienced in palliative care patients and are often preventable. Identification of risk factors for ADRs may prevent occurrences in the complex palliative care patient.