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Review of Dopamine Antagonists for Nausea and Vomiting in Palliative Care Patients. 多巴胺拮抗剂治疗姑息治疗患者恶心呕吐的研究进展。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2023-10-16 DOI: 10.1080/15360288.2023.2268065
Grace Jenkins

Symptoms of nausea and vomiting are common in palliative care and hospice patients. One of the many classes of medications used for the treatment of nausea and vomiting is dopamine receptor antagonists which are particularly helpful for treating nausea mediated by the chemoreceptor trigger zone (CTZ) and impaired gastrointestinal function. While dopamine antagonists can be very effective treatments for nausea they should be used with caution as they carry the risk of QTc prolongation, have a FDA black box warning for tardive dyskinesia (TD), and increased risk of precipitating psychosis and death in patients with dementia. This review will cover haloperidol, olanzapine, prochlorperazine, and metoclopramide for treatment of nausea and vomiting including evidence of efficacy, pharmacokinetics, and pharmacodynamics to improve safe and effective utilization in clinical practice. This includes medication receptor site affinities at histaminic, muscarinic, serotonergic, and alpha-adrenergic receptors which can help providers anticipate potential adverse effects and risk of extrapyramidal symptoms (EPS), TD, and QTc prolongation. This review also includes considerations for dose adjustments based on renal function, hepatic function, and age. Understanding the pharmacology of dopamine antagonists can help providers choose the best treatment for control of nausea and vomiting and subsequently improve patients' quality of life.

恶心和呕吐的症状在姑息治疗和临终关怀患者中很常见。用于治疗恶心和呕吐的多种药物之一是多巴胺受体拮抗剂,其特别有助于治疗由化学受体触发区(CTZ)介导的恶心和胃肠功能受损。虽然多巴胺拮抗剂可以非常有效地治疗恶心,但应谨慎使用,因为它们具有QTc延长的风险,对迟发性运动障碍(TD)有美国食品药品监督管理局的黑匣子警告,并增加痴呆患者引发精神病和死亡的风险。这篇综述将涵盖氟哌啶醇、奥氮平、普氯哌嗪和甲氧氯普胺治疗恶心和呕吐,包括疗效、药代动力学和药效学证据,以提高在临床实践中的安全有效利用率。这包括组胺受体、毒蕈碱受体、5-羟色胺能受体和α-肾上腺素能受体的药物受体位点亲和力,这可以帮助提供者预测潜在的不良反应和锥体外系症状(EPS)、TD和QTc延长的风险。这篇综述还包括根据肾功能、肝功能和年龄调整剂量的考虑因素。了解多巴胺拮抗剂的药理学可以帮助提供者选择控制恶心和呕吐的最佳治疗方法,从而提高患者的生活质量。
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引用次数: 0
A Year in Review: 2023. 一年回顾:2023.
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2024-02-12 DOI: 10.1080/15360288.2024.2313946
Laura Meyer-Junco
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引用次数: 0
A Tool for Deprescribing Antithrombotic Medication in Palliative Cancer Patients: A Retrospective Evaluation. 癌症姑息治疗患者的抗血栓药物处方工具:回顾性评估
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2023-12-18 DOI: 10.1080/15360288.2023.2288093
Angela Riveras, Mirjam Crul, Jozien van der Kloes, Monique Steegers, Bregje Huisman

Treating palliative cancer patients with antithrombotics is challenging because of the higher risk for both venous thromboembolism and major bleeding. There is a lack of available guidelines on deprescribing potentially inappropriate antithrombotics. We have therefore created an antithrombotics scheme to aid in (de)prescribing antithrombotics. A retrospective single-center clinical cohort observational study was performed to evaluate it. Patients with solid tumors with a life expectancy of less than 3 months seen by the palliative team were included. Comparisons were made between patients who were treated according to the antithrombotics scheme and those who were not. 47.6% of patients used antithrombotics. One hundred and eleven patients were included for analysis. Most patients used antithrombotics according to the scheme (n = 80, 72.1%). Eleven patients experienced a clinical event, seven patients in the scheme adherence group (9.9%) and four in the no scheme adherence group (13.8%), which was not statistically significant (p = 0.726). The higher frequency of clinical events in the group without scheme adherence suggests that (de)prescribing antithrombotics according to the antithrombotics scheme is safe. The results of this study suggest that the antithrombotics scheme could aid healthcare professionals identifying possible inappropriate antithrombotics in palliative cancer patients. Further prospective research is needed to investigate this tool.

由于静脉血栓栓塞和大出血的风险较高,用抗血栓药物治疗姑息治疗癌症患者具有挑战性。目前还缺乏关于停用可能不适当的抗血栓药物的指南。因此,我们制定了一项抗血栓药物计划,以帮助(取消)抗血栓药物处方。我们进行了一项回顾性单中心临床队列观察研究,以对其进行评估。研究对象包括姑息治疗小组接诊的预期生存期少于 3 个月的实体瘤患者。对按照抗血栓方案治疗的患者和未按照该方案治疗的患者进行了比较。47.6%的患者使用了抗血栓药物。有 111 名患者被纳入分析范围。大多数患者按照计划使用了抗血栓药物(n = 80,72.1%)。11 名患者发生了临床事件,其中遵守方案组 7 人(9.9%),未遵守方案组 4 人(13.8%),无统计学意义(P = 0.726)。未遵守计划组发生临床事件的频率较高,这表明根据抗血栓计划(取消)抗血栓药物处方是安全的。本研究结果表明,抗血栓药物方案可帮助医护人员识别姑息治疗癌症患者中可能存在的不适当抗血栓药物。还需要进一步的前瞻性研究来探讨这一工具。
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引用次数: 0
Use of Fosaprepitant for Management of Suspected Antimicrobial-Associated Nausea: A Case Report. 使用磷沙匹坦治疗疑似抗菌素相关恶心:1例报告。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2023-11-20 DOI: 10.1080/15360288.2023.2282465
Brandon Perkovich, Rabia S Atayee, Jennifer S Kim, Tamara Rubenzik

Intractable nausea can occur in numerous settings. We report on a 49-year-old woman with a past medical history of cystic fibrosis (CF) with chronic hypoxia, chronic nausea, complex infection history and frequent hospitalizations who was admitted to an academic medical center with a CF exacerbation. Her chronic nausea worsened with the use of antimicrobials, and she was unable to tolerate dopamine or serotonin antagonist antiemetics. Nausea persisted despite the use of benzodiazepines and antihistamines. She was given a one-time dose of fosaprepitant 150 mg intravenously (IV) with marked improvement of her nausea. During subsequent exacerbations, she again developed severe nausea which continued to respond well to a one-time dose of fosaprepitant 150 mg IV. Fosaprepitant is a substance P/neurokinin-1 (NK1) receptor antagonist that is FDA-approved for the prevention of chemotherapy-induced nausea and vomiting and has been used to prevent post-operative nausea and vomiting. Its use in other contexts has not been well established. This case suggests a role for fosaprepitant in the management of nausea outside the context of chemotherapy or general anesthesia.

难治性恶心可发生在许多情况下。我们报告一名49岁女性,既往有囊性纤维化(CF)病史,伴慢性缺氧、慢性恶心、复杂感染史和频繁住院,因CF加重入住学术医疗中心。她的慢性恶心随着抗菌素的使用而恶化,并且她无法耐受多巴胺或血清素拮抗剂止吐药。尽管使用苯二氮卓类药物和抗组胺药,恶心仍然存在。患者一次性静脉滴注氟沙匹坦150毫克,恶心症状明显改善。在随后的加重中,患者再次出现严重的恶心,对一次性剂量的fosaprepitant 150mg IV持续反应良好。fosaprepitant是一种物质P/神经动素-1 (NK1)受体拮抗剂,fda批准用于预防化疗引起的恶心和呕吐,并已用于预防术后恶心和呕吐。它在其他语境中的用法尚未得到很好的确定。本病例提示氟沙吡坦在化疗或全身麻醉以外的恶心治疗中的作用。
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引用次数: 0
A Multicenter Retrospective Observational Study Analyzing the Effect of Polypharmacy on Oxycodone Tolerability. 一项多中心回顾性观察研究,分析多重用药对羟考酮耐受性的影响。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2024-01-16 DOI: 10.1080/15360288.2023.2301341
Katsuya Makihara, Yoshihiro Yamamoto, Masayuki Miyazaki, Maho Taguchi, Junya Sato, Hisamitsu Takase, Yasuhito Uezono

Polypharmacy is becoming increasingly troublesome in the treatment of cancer. The aim of this study was to explore the effects of concomitant polypharmacy comprising drugs that inhibit CYP3A4 and/or CYP2D6 on the oxycodone tolerability in patients with cancer. We conducted a multicenter retrospective study encompassing 20 hospitals. The data used for the study were obtained during the first 2 wk of oxycodone administration. The incidence of oxycodone discontinuation or dose reductions due to side effects and oxycodone-induced nausea and vomiting (OINV) were compared between patients not treated with either inhibitor and those treated with concomitant CYP3A4 or CYP2D6 inhibitors. The incidence of oxycodone discontinuation or dose reductions in patients treated with ≥3 concomitant CYP2D6 inhibitors (18.2%) tended to be higher than that in patients without this treatment (8.2%; p = 0.09). Moreover, the incidence of OINV in patients treated with 2 concomitant CYP3A4 inhibitors (29.8%) was significantly higher than that in patients without this treatment (15.5%; p = 0.049). Multivariate analysis showed that more than two concomitant CYP3A4 inhibitors and no concomitant use of naldemedine were independent risk factors for OINV. Concomitant polypharmacy involving CYP3A4 inhibitors increases the risk of OINV. Therefore, medications concomitantly used with oxycodone should be optimized.

在癌症治疗过程中,多药治疗正变得越来越麻烦。本研究旨在探讨癌症患者同时服用抑制 CYP3A4 和/或 CYP2D6 的药物对羟考酮耐受性的影响。我们在 20 家医院开展了一项多中心回顾性研究。研究使用的数据是在服用羟考酮的头两周内获得的。我们比较了未使用两种抑制剂的患者与同时使用 CYP3A4 或 CYP2D6 抑制剂的患者因副作用和羟考酮诱发的恶心和呕吐(OINV)而停药或减量的发生率。同时接受≥3种CYP2D6抑制剂治疗的患者停用羟考酮或减少剂量的发生率(18.2%)往往高于未接受该治疗的患者(8.2%;P = 0.09)。此外,同时接受两种 CYP3A4 抑制剂治疗的患者的 OINV 发生率(29.8%)明显高于未接受该治疗的患者(15.5%;P = 0.049)。多变量分析显示,同时服用两种以上CYP3A4抑制剂和未同时服用纳尔地美定是导致OINV的独立风险因素。同时使用多种涉及 CYP3A4 抑制剂的药物会增加发生 OINV 的风险。因此,应优化与羟考酮同时使用的药物。
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引用次数: 0
Polypharmacy and Reversible Drug Induced QT Prolongation in a Patient with Advanced Cancer: Case Report. 一名晚期癌症患者的多重用药和可逆药物诱发的 QT 间期延长:病例报告。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2024-01-05 DOI: 10.1080/15360288.2023.2297218
Gabriela Cerdà, Joaquim Julià-Torras, Jesús González-Barboteo, Margarita Romeo, Agnès Calsina-Berna

QT prolongation is related to the development of ventricular arrhythmias such as Torsade de Pointes (TdP) that can lead to sudden cardiac death. Several drugs used in the treatment of patients with advanced cancer may induce QT prolongation due to their interference with cardiac ion channels. Some patients may be at higher risk if predisposing factors are present. Herein we present the case of a patient with advanced cancer under anti-tumor treatment with radical intention that developed a reversible drug-induced QT prolongation when simultaneously treated with methadone, haloperidol and fluoxetine that presented with chest pain and bradycardia. An approach to cancer patients at risk for drug-induced QT prolongation is discussed highlighting the need of a thorough medication review with a special focus in the patient with polypharmacy.

QT 延长与室性心律失常的发生有关,如可导致心脏性猝死的 Torsade de Pointes(TdP)。用于治疗晚期癌症患者的几种药物可能会因干扰心脏离子通道而诱发 QT 间期延长。如果存在易感因素,一些患者的风险可能会更高。在此,我们介绍了一例正在接受根治性抗肿瘤治疗的晚期癌症患者,该患者在同时接受美沙酮、氟哌啶醇和氟西汀治疗时,出现了可逆的药物诱导 QT 间期延长,并伴有胸痛和心动过缓。本文讨论了针对有药物诱发 QT 间期延长风险的癌症患者的治疗方法,强调了对患者进行全面用药检查的必要性,并特别强调了对使用多种药物的患者进行用药检查的重要性。
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引用次数: 0
"I Just Don't Feel Heard": A Case Study on Opioid Use Disorder and Pain Management. “我只是不觉得被听到”:阿片类药物使用障碍和疼痛管理的案例研究。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-08-28 DOI: 10.1080/15360288.2023.2250340
Aila Malik, Peter D Vu, A Sarah Cohen, Vishal Bansal, Morgan R Cowan, Gregory M Blazek, Tiffany Champagne-Langabeer

The nation's opioid epidemic requires a paradigm shift in the way patients with co-occurring opioid use disorder are treated during episodes of acute pain. Patients are often introduced to prescription opioids after an extremity fracture or sprain or resulting from musculoskeletal back, abdominal, or dental pain. Opioid naive patients who receive their first opioid prescription on discharge from the emergency department may be more likely to develop chronic opioid use compared to patients receiving non-opioid pain medications. This case report will highlight one patient's journey including initial prescription opioid use, escalation into illicit opioids, entry to a recovery and treatment program, discussions with her physician about alternative therapies, and barriers to satisfactory pain relief. A shared decision-making model will be explored.

美国的阿片类药物流行需要在急性疼痛发作期间治疗同时发生阿片类药物使用障碍的患者的方式上进行范式转变。患者通常在四肢骨折或扭伤或由背部、腹部或牙痛引起的肌肉骨骼疼痛后引入处方阿片类药物。与接受非阿片类止痛药的患者相比,从急诊科出院时首次接受阿片类药物处方的阿片类药物初治患者更有可能发展为慢性阿片类药物使用。本病例报告将重点介绍一位患者的旅程,包括最初的处方阿片类药物使用,升级为非法阿片类药物,进入康复和治疗计划,与医生讨论替代疗法,以及令人满意的疼痛缓解的障碍。探讨共享决策模式。
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引用次数: 0
Mpox Pain Management with Topical Agents: A Case Series. m痘疼痛管理与局部药物:一个案例系列。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-08-31 DOI: 10.1080/15360288.2023.2250762
Mariam Shabbir, Maria Lorraine Bugayong, Michael Anthony DeVita

With the recent spread in monkeypox cases, continuous efforts are made to manage the disease efficiently. Pain at the site of monkeypox lesions and in areas of skin breakdown can be severe. The origin of pain is likely neuropathic. The Centers for Disease Control and Prevention (CDC) has issued general guidelines to control pain with non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, gabapentin, and topical agents such as corticosteroids and lidocaine. Guidelines circulated by the World Health Organization (WHO) suggest acetaminophen, tramadol, opioids, and/or topical lidocaine for symptomatic pain management. No first line agent with proven beneficial effect has been recommended in these patients. We present two patients' painful experiences with Monkeypox and suggest lessons learned.

随着最近猴痘病例的传播,正在继续努力有效地管理该疾病。猴痘病变部位和皮肤破裂部位的疼痛可能很严重。疼痛的来源可能是神经性的。美国疾病控制与预防中心(CDC)发布了使用非甾体抗炎药(NSAIDs)、对乙酰氨基酚、加巴喷丁以及皮质类固醇和利多卡因等局部药物控制疼痛的一般指南。世界卫生组织(WHO)发布的指南建议使用对乙酰氨基酚、曲马多、阿片类药物和/或局部利多卡因来治疗症状性疼痛。在这些患者中,没有一线药物被证明是有益的。我们介绍了两例猴痘患者的痛苦经历,并提出了经验教训。
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引用次数: 0
Oxygen Therapy in the Last Days and Hours of Life: From Evidence to Practice. 氧气疗法在生命的最后几天和几个小时:从证据到实践。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-07 DOI: 10.1080/15360288.2023.2250332
Mónica Carqueijó
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引用次数: 0
Using Interdisciplinary Teams to Mitigate the Effects of Drug Shortages in Palliative Care: The Case of Lorazepam Injection. 使用跨学科团队减轻姑息治疗中药物短缺的影响:以洛拉西泮注射液为例。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-11-28 DOI: 10.1080/15360288.2023.2269899
Natalie Hartung, Zainab Fatima, Danielle M Noreika, J Brian Cassel, Katie S Adams

Given the rising frequency of drug shortages in hospitals, interdisciplinary collaboration is necessary to manage medications, modify electronic medical records, and evaluate safety outcomes. One such shortage impacted lorazepam injection, a medication commonly used in palliative care to treat anxiety, agitation, and seizures. In anticipation of the lorazepam shortage in the summer of 2022, pharmacy staff collaborated with palliative care physicians to identify alternative treatment recommendations when providers were prohibited from ordering lorazepam injection. Before the shortage, lorazepam was used an average of 95 times per month on the palliative care unit. The overall use of benzodiazepines decreased substantially following the recommendation for the therapeutic alternative, midazolam, during the shortage. Once the shortage ended, use roughly returned to pre-shortage baselines. During this time, there were no patient safety events documented on the palliative care unit. Moreover, no changes to the care experience were reported by patients, family/caregivers, providers, or staff. The collaborative effort between pharmacy and palliative care specialists resulted in alternative treatments for palliative care patients during the drug shortage. This preserved the hospital's supply of lorazepam injection for a patient population with no suitable alternatives while still allowing for management of palliative patients.

鉴于医院药物短缺的频率不断上升,跨学科合作对于管理药物、修改电子医疗记录和评估安全性结果是必要的。其中一种短缺影响了劳拉西泮注射液,这是一种常用于姑息治疗的药物,用于治疗焦虑、烦躁和癫痫。由于预计2022年夏天会出现劳拉西泮短缺,当提供者被禁止订购劳拉西泮注射液时,药房工作人员与姑息治疗医生合作,确定替代治疗建议。在药物短缺之前,劳拉西泮在姑息治疗室平均每月使用95次。在短缺期间,根据治疗替代品咪达唑仑的建议,苯二氮卓类药物的总体使用量大幅下降。一旦短缺结束,使用大致恢复到短缺前的基线。在此期间,姑息治疗室没有记录任何患者安全事件。此外,患者、家人/护理人员、提供者或工作人员未报告护理体验发生变化。药房和姑息治疗专家之间的合作为药物短缺期间的姑息治疗患者提供了替代治疗。这为没有合适替代品的患者群体保留了医院的劳拉西泮注射液供应,同时仍允许对姑息性患者进行管理。
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引用次数: 0
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Journal of Pain & Palliative Care Pharmacotherapy
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