A common opioid analgesic for cancer pain and, to a lesser extent, non-cancer pain, is hydromorphone (HM). Oral formulations as well as subcutaneous, intravenous, and other routes are frequently used for its administration. Its pharmacokinetics and pharmacodynamics have also been extensively researched. This article examines the pharmacological properties of hydromorphone and the development of its use both domestically and internationally with the goal of serving as a reference for the sensible clinical use of this medication. Key words Hydromorphone, Pharmacological action, Route of administration, Cancer pain, Adverse effects.
- MeSH
- bolest farmakoterapie MeSH
- hydromorfon * terapeutické užití farmakologie aplikace a dávkování MeSH
- lidé MeSH
- nádorová bolest farmakoterapie MeSH
- opioidní analgetika * terapeutické užití farmakologie škodlivé účinky MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Adequate postoperative pain treatment is important for quality of life, patient satisfaction, rehabilitation, function, and total opioid consumption, and might lower both the risk of chronic postoperative pain and the costs for society. Prolonged opioid consumption is a well-known risk factor for addiction. Previous studies in upper extremity surgery have shown that total opioid consumption is a third of the amount prescribed, which can be explained by package size. The aim of this study was to examine whether implementation of prepacked takehome analgesia bags reduced the quantity of prescribed and dispensed opioids. MATERIAL AND METHODS: We introduced prepacked take-home analgesia bags for postoperative pain treatment in outpatient surgery. The bags came in two sizes, each containing paracetamol, etoricoxib, and oxycodone. The first 147 patients who received the prepacked analgesia bags were included in the study, and received a questionnaire one month after surgery covering self-assessed pain (visual analog scale of 0-10) and satisfaction (0-5), as well as opioid consumption. Prescription data after introducing the analgesia bags were compared with data before the bags were introduced. RESULTS: Of the 147 patients included in the study, 58 responded. Compared to standard prescription (small bag group: 14 oxycodone immediate release capsules (5 mg), large bag group: additional 28 oxycodone extended release tablets (5 mg), based on the smallest available package), the patients in the small analgesia bag group received 50% less oxycodone and 67% less for the large bag group. Patients with small bags consumed a median of 0.0 mg oxycodone and those with large bags consumed a median of 25.0 mg oxycodone. The median satisfaction was 5.0 (range: 2-5) and the median pain score was acceptable at the first postoperative day. Prescription data showed a significant reduction of 60.0% in the total amount of prescribed opioids after the introduction of prepacked analgesia bags. CONCLUSIONS: The introduction of prepacked analgesia bags dramatically reduced the quantity of opioids prescribed after outpatient hand surgery. Patient satisfaction was high and the postoperative pain level was acceptable. KEY WORDS: analgesia, hand surgery, opioids, outpatint surgery, wrist surgery.
- MeSH
- ambulantní chirurgické výkony * metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- management bolesti metody MeSH
- měření bolesti MeSH
- opioidní analgetika * aplikace a dávkování MeSH
- oxykodon aplikace a dávkování MeSH
- paracetamol aplikace a dávkování terapeutické užití MeSH
- pooperační bolest * prevence a kontrola farmakoterapie MeSH
- ruka chirurgie MeSH
- spokojenost pacientů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Endogenous opioid peptides serve as potent analgesics through the opioid receptor (OR) activation. However, they often suffer from poor metabolic stability, low lipophilicity, and low blood-brain barrier permeability. Researchers have developed many strategies to overcome the drawbacks of current pain medications and unwanted biological effects produced by the interaction with opioid receptors. Here, we tested multifunctional enkephalin analogs LYS739 (MOR/DOR agonist and KOR partial antagonist) and LYS744 (MOR/DOR agonist and KOR full antagonist) under in vivo conditions in comparison with MOR agonist, morphine. We applied 2D electrophoretic resolution to investigate differences in proteome profiles of crude membrane (CM) fractions isolated from the rat brain cortex and hippocampus exposed to the drugs (10 mg/kg, seven days). Our results have shown that treatment with analog LYS739 induced the most protein changes in cortical and hippocampal samples. The identified proteins were mainly associated with energy metabolism, cell shape and movement, apoptosis, protein folding, regulation of redox homeostasis, and signal transduction. Among these, the isoform of mitochondrial ATP synthase subunit beta (ATP5F1B) was the only protein upregulation in the hippocampus but not in the brain cortex. Contrarily, the administration of analog LYS744 caused a small number of protein alterations in both brain parts. Our results indicate that the KOR full antagonism, together with MOR/DOR agonism of multifunctional opioid ligands, can be beneficial in treating chronic pain states by reducing changes in protein expression levels but retaining analgesic efficacy.
- MeSH
- analgetika MeSH
- enkefaliny metabolismus MeSH
- hipokampus metabolismus MeSH
- krysa rodu rattus MeSH
- morfin * farmakologie MeSH
- mozek metabolismus MeSH
- opioidní analgetika farmakologie MeSH
- receptory opiátové mu * metabolismus MeSH
- receptory opiátové metabolismus MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Bolest je komplikovaná subjektivní entita, kterou je obtížné kvantifikovat a léčit. Jednotlivci se prostřednictvím svých životních zkušeností učí pojmu bolesti a koncepce vnímání bolesti se u člověka mění. Přestože bolest obvykle plní adaptivní roli, může mít nepříznivé účinky na kvalitu života – na funkční, sociální a psychologickou rovnováhu. Proto je třeba respektovat sdělení jednotlivce o tom, že prožívá a cítí bolest, či sledovat různé symptomy bolesti. Perioperační léčba bolesti je dnes součástí komplexní péče o pacienty, kteří se podrobují operačním zákrokům, a je spojena s četnými benefity pro pacienta i společnost. V současnosti je k dispozici dostatek léků, lékových forem, modalit léčby i dostatek literárních údajů, vč. poznatků o organizaci léčby pooperační bolesti. Komplexní péče začíná již před operačním výkonem na specializovaných ambulancích správnou přípravou pacienta na anestezii a operační výkon. Samotná léčba pooperační bolesti je podobně jako péče o pacienta po chirurgickém výkonu multidisciplinárním týmovým úkolem, na němž se podílejí zejména ošetřující lékař, operatér, anesteziolog a sestry pooperačního oddělení. Součástí této rozsáhlé spolupráce jsou specializované týmy na léčbu akutní pooperační bolesti, které mají úlohu především konziliární, vzdělávací a organizační a pomáhají zajišťovat specializované léčebné postupy tišení bolesti. Je nutné, aby všechny specialisty spojovaly základní znalosti a jejich uplatňování v praxi.
Pain is a complicated subjective entity that is difficult to quantify and treat. Individuals learn the concept of pain through their life experience, and a person’s concept of pain perception changes. Although pain usually fulfills an adaptive role, it can have adverse effects on quality of life – functional, social and psychological balance. Therefore, it is necessary to respect the communication of the individual experiencing and feeling pain, or to monitor the various symptoms of pain. Today, perioperative pain management is part of the comprehensive care of patients undergoing surgery, and is associated with numerous benefits for the patient and society. Currently, there are enough drugs, dosage forms, treatment modalities available, as well as enough literary data, incl. knowledge about the organization of postoperative pain treatment. Comprehensive care begins even before surgery in specialized outpatient clinics with the proper preparation of the patient for anesthesia and surgery. The treatment of postoperative pain itself is similar to the care of a patient after a surgical procedure, a multidisciplinary team task, in which the attending physician, surgeon, anesthetist and nurses of the postoperative department participate in particular. Part of this extensive collaboration are specialized teams for the treatment of acute postoperative pain, which primarily have a conciliatory, educational and organizational role, and help to provide specialized treatment procedures for pain relief. It is necessary for all specialists to combine basic knowledge and their application in practice.
- MeSH
- analgetika aplikace a dávkování farmakologie klasifikace MeSH
- analgezie metody MeSH
- antiflogistika nesteroidní aplikace a dávkování farmakologie klasifikace škodlivé účinky MeSH
- chirurgie operační škodlivé účinky MeSH
- hormony kůry nadledvin aplikace a dávkování MeSH
- lidé MeSH
- metamizol aplikace a dávkování MeSH
- morfin aplikace a dávkování MeSH
- opioidní analgetika aplikace a dávkování klasifikace MeSH
- paracetamol aplikace a dávkování MeSH
- perioperační péče metody MeSH
- pooperační bolest * farmakoterapie terapie MeSH
- pooperační péče * metody MeSH
- urychlená pooperační rehabilitace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- chronická bolest terapie MeSH
- elektrostimulační terapie * metody přístrojové vybavení MeSH
- infuzní pumpy MeSH
- lidé středního věku MeSH
- lidé MeSH
- morfin * aplikace a dávkování MeSH
- subarachnoidální prostor MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- bolest * farmakoterapie MeSH
- dítě MeSH
- fentanyl aplikace a dávkování škodlivé účinky MeSH
- lidé MeSH
- morfin aplikace a dávkování farmakologie škodlivé účinky MeSH
- opioidní analgetika * aplikace a dávkování klasifikace škodlivé účinky MeSH
- oxykodon aplikace a dávkování farmakologie MeSH
- tramadol aplikace a dávkování farmakologie škodlivé účinky MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Protracted opioid withdrawal is considered to be a traumatic event with many adverse effects. However, little attention is paid to its consequences on the protein expression in the rat brain. A better understanding of the changes at the molecular level is essential for designing future innovative drug therapies. Our previous proteomic data indicated that long-term morphine withdrawal is associated with altered proteins functionally involved in energy metabolism, cytoskeletal changes, oxidative stress, apoptosis, or signal transduction. In this study, we selected peroxiredoxin II (PRX II) as a marker of oxidative stress, 14-3-3 proteins as adaptors, and creatine kinase-B (CK-B) as a marker of energy metabolism to detect their amounts in the brain cortex and hippocampus isolated from rats after 3-month (3 MW) and 6-month morphine withdrawal (6 MW). Methodically, our work was based on immunoblotting accompanied by 2D resolution of PRX II and 14-3-3 proteins. Our results demonstrate significant upregulation of PRX II in the rat brain cortex (3-fold) and hippocampus (1.3-fold) after 3-month morphine abstinence, which returned to the baseline six months since the drug was withdrawn. Interestingly, the level of 14-3-3 proteins was downregulated in both brain areas in 3 MW samples and remained decreased only in the brain cortex of 6 MW. Our findings suggest that the rat brain cortex and hippocampus exhibit the oxidative stress-induced vulnerability represented by compensatory upregulation of PRX II after three months of morphine withdrawal.
- MeSH
- abstinenční syndrom * metabolismus MeSH
- hipokampus metabolismus MeSH
- krysa rodu rattus MeSH
- morfin metabolismus MeSH
- mozek metabolismus MeSH
- peroxiredoxiny metabolismus farmakologie MeSH
- proteiny 14-3-3 metabolismus MeSH
- proteomika MeSH
- upregulace MeSH
- závislost na morfiu * MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
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- MeSH
- buprenorfin * aplikace a dávkování farmakologie terapeutické užití MeSH
- chronická bolest etiologie farmakoterapie prevence a kontrola MeSH
- lidé MeSH
- management bolesti metody MeSH
- morfin terapeutické užití MeSH
- nádorová bolest farmakoterapie prevence a kontrola MeSH
- opioidní analgetika farmakologie klasifikace škodlivé účinky terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
