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Diego, del Río Laura 1977. "Independent drug information for medicines management." Doctoral thesis, Universitat Pompeu Fabra, 2013. http://hdl.handle.net/10803/129850.
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On the 50th anniversary of the creation of the first medicines information center, the core of this PhD Thesis offers an insider perspective and provides several examples of independent drug information, with a focus on new drugs. On the one hand, it provides an overview of the origins and challenges current medicines information centers within public healthcare organizations are experiencing. Several strategic lines aiming for information centers continue to meet drug information needs in the actual healthcare and economic context are presented. Additionally, various examples of independent drug information as a tool for medicines management are as well provided. First, the evaluation of the place in therapy of methylnaltrexone, the first peripherally acting mu-opioid receptor antagonist, licensed for opioid-induced constipation in patients with advanced illness. Second, the role of three novel opioid antagonists (methylnaltrexone, alvimopan and modified release naloxone) and four other agents (NKTR-118, TD-1211, ADL-7445 and ADL-5945), which are currently under different stages of clinical development, in the management of opioid-induced bowel dysfunction is discussed. The annexes compile two editorials, one on new drugs’ policies and a second on how should the pharmaceutical benefit scheme be reviewed in order to maximize its economic impact without compromising healthcare quality. For illustrative purposes, several drug information bulletins are enclosed, reviewing the place in therapy of other newly marketed drugs.<br>En el contexto del 50 aniversario de la creación del primer centro de información de medicamentos, esta tesis ofrece una perspectiva interna y varios ejemplos de actividades de información independiente, centrándose especialmente en los nuevos medicamentos. Por un lado, revisa los orígenes y retos a los que se enfrentan los centros de información de medicamentos de la sanidad pública hoy en día. En este sentido, se proponen varias líneas estratégicas para garantizar que éstos centros continúen respondiendo a las necesidades de información en el actual contexto económico y sanitario. Adicionalmente, se presentan varias actividades de información independiente que sirven de herramienta para la gestión del medicamento. En primer lugar, la evaluación del lugar en terapéutica de la metilnaltrexona, el primer antagonista periférico del receptor mu-opioide, indicado para el tratamiento del estreñimiento inducido por opioideis en pacientes con enfermedad avanzada. En segundo lugar, se revisa el papel de los nuevos antagonistas opioides (metilnaltrexona, alvimopan y naloxona de liberación prolongada) y de otros cuatro agentes (NKTR-118, TD-1211, ADL-7445 y ADL-5945), actualmente en diferentes fases de desarrollo clínico, en el manejo de la disfunción intestinal inducida por opioides. Los anexos compilan dos editoriales, una primera sobre las políticas de nuevos medicamentos y la segunda sobre cómo maximizar el impacto en la reducción de la oferta de medicamentos públicamente financiados sin comprometer la calidad asistencial. A modo ilustrativo, se incluyen varios boletines de información de medicamentos en los que se revisa el lugar en la terapéutica de otros nuevos medicamentos recientemente comercializados.
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Stetskevych, Olena. "How to Overcome Barriers to Adequate Pain Management in Ukraine." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32003.
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There is a large gap between contemporary evidence-based remedies for pain control and what is offered to Ukrainian patients with pain. Having thousands of people needlessly suffer from avoidable pain forces a consideration of 1) what prevents from their access to pain relief, 2) are their human rights being violated and 3) how can the situation be improved. In order to identify the obstacles to adequate pain management in Ukraine I collected evidence using two methods. First, I designed a questionnaire for the Ukrainian doctors, received approval from the University of Ottawa Ethics Board, distributed the questionnaire among potential responders and then organized the obtained results. Second, I did an extensive literature review to provide evidence from the patients. Then I analysed the provisions of Ukrainian domestic and international legislation as well as the available case law to find out if the human rights of Ukrainian patients and doctors are being violated by denial of adequate pain relief. According to my findings, the barriers to pain control in Ukraine are multidimensional and interdependent. They cause violations of human rights, which are not being effectively defended through the courts of Ukraine. These findings call for a more constructive approach to the development of the Ukrainian health law and policy, which I offer in this thesis.
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Isherwood, Ruth Jayne. "Opioid-related side-effects and opioid-induced hyperalgesia." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6598/.
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Introduction: Opioids are widely used for the management of cancer and chronic non-cancer pain and the maintenance management of patients with a history of substance misuse. Increasingly the use of opioids is being scrutinised as patients are prescribed opioids for longer periods and the long-term effects of the opioids becomes clinically more relevant and evident. Our work has explored the prevalence of opioid-related side-effects in patients who are prescribed opioids and explored the clinically relevant phenomenon of opioid-induced hyperalgesia. . Methods: Patients were recruited who were prescribed opioids for the management of cancer and non-cancer pain or substance misuse. Quantitative data was collected to explore the prevalence and severity of opioid related side-effects, the impact of opioids on cognitive function and the effect of opioids on peripheral nerve function through quantitative sensory testing. Testing the sensory processing of patients who are on opioids has revealed altered thermal thresholds and the presence of wind-up at non-painful sites indicating central sensitisation. Qualitative description was used to explore the patient experience of an episode of opioid toxicity. Results: Patients have a significant burden of side-effects which have often not been recognised by clinicians. Using the Addenbrooke’s Cognitive Examination much more cognitive impairment has been revealed than has previously been recognised. Altered thermal thresholds and wind-up at non-painful sites suggests altered pain processing as a result of opioids. Themes from the qualitative description highlighted the coping strategies patients’ develop when managing with significant side-effects and toxicity, the covert self-management of their pain and the need to exert control. One of the most significant findings from the qualitative research was the finding of altered sensation and pain description associated with other features of opioid toxicity. Conclusions: The impact of opioids on the cognitive function of patients has significant implications in terms of patients’ involvement in decision-making and functioning in everyday life. The qualitative data reflects the burden of side effects and the descriptions of patients suggest that opioid-induced hyperalgesia exists as part of the spectrum of opioid toxicity. This finding may help physicians identify patients who are developing opioid-induced hyperalgesia and allow them to intervene earlier with a proactive approach.
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Harvey, Jane Ellen. "Long-term and high dose opioid medicine use in the U.K." Thesis, University of Nottingham, 2018. http://eprints.nottingham.ac.uk/52175/.
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Introduction The number of prescriptions dispensed for opioid medicines has increased in the U.K. in the last two decades and studies have shown patients are receiving opioids for longer periods than in the past. There is a lack of evidence as to the effectiveness of these drugs when used long-term, as efficacy evidence is taken from short clinical trials in populations who do not have the comorbidities commonly seen in chronic pain patients. Large observational studies of patients prescribed opioid medicines outside of clinical trials, have identified that some patients taking long-term opioids are reporting they are still in high levels of pain. There is also a concern that patients are receiving high dosages of opioid medicines without effective pain relief. However, no studies in the U.K. have looked at the proportion of patients who continue to receive opioids (for all conditions) in the long-term or at high dosages so we do not know how opioid use develops in the U.K. Research from other countries has also identified that long-term and high dose use is linked to patient characteristics such as patient demographics and psychological and physical comorbidities. For example, a prior history of depression has been found to increase the risk of long-term and high dose use. This is of concern as this may indicate that patients may be potentially medicating the depression with the opioid. This may not be the case in the U.K. due to key factors such as the structure of the health system, so the aim of this thesis was to see if this phenomenon could potentially be occurring in the U.K. Methods This thesis was a retrospective observational cohort study of patients receiving opioid medicines for non-cancer conditions using data from a U.K. derived primary care database, the clinical practice research datalink (CPRD). Patients were included in the study if they received a prescription for opioid medication at any point in the year 2009 and followed, where possible to January 2015 (though data was collected for baseline variables prior to 2009). This thesis consists of a series of longitudinal analyses that attempt to define and describe the probability of long-term use and proportion of patients who receive high dosages in the U.K and seeks to understand how baseline characteristics (such as having a comorbid condition occurring before opioid use starts) affect the probability of long-term and high dose use. Competing risks methods were used to calculate the probability of continuation of opioid medicines (using death as a competing risk) and to determine long-term use. Cox regression models were used to determine whether baseline factors (such as prior antidepressant use) were associated with discontinuation of long-term use. Calculation of odds ratios were used to predict whether baseline characteristics predicted high dose use. Cox regression was also used to predict time to discontinuation of high dose use. Results In the U.K., 10.58% of patients received opioid medicines to treat non-cancer pain in the year 2009. Of the non-cancer patients included in the study, 41.41% were patients who received opioids in the six months prior to 2009 and the remaining were new users of opioid medicines. In the new user opioid group, 5.75% continued to be prescribed opioids for at least one year. When including new and existing users of opioid medicines, one in thirty people in the U.K. population who started opioids for non-cancer pain in 2009 were continuously prescribed opioids for a full year. Patients who were female, received an antidepressant before opioid use started and were in the youngest age category were more likely to continue opioid use past 2 years. The probability of continuing to take opioid medicines is higher in patients who have been receiving opioids for longer and are on higher dosages; in patients who had received over 10mg OMEQ for over two years, over half of patients continued to receive prescriptions for opioid medicines for the five year period study after 2009. In the U.K. population, one in a hundred opioid medicine users were prescribed a high dose (estimated dosage received >120mg oral morphine equivalents per day for at least 91 days) for non-cancer pain in their first 91 days of use in the year 2009. Patients receiving high dosages were likely to be receiving multiple opioid drug types and to receive preparations with multiple release profiles. In new users of opioid medication, the odds of high dose use were increased in patients who were younger (aged 18-49 years), had 3 or more comorbidities or were in receipt of an antidepressant or benzodiazepine and/or anti-anxiety drug before or after opioid use started. In new and existing users of opioid medicines, patients who were receiving high dosages were more likely to be diagnosed or be recorded with symptoms of depression or anxiety and to have been prescribed an antidepressant or benzodiazepine and/or other anti-anxiety drug in the youngest age group compared to the older age groups. Of the patients that were prescribed high dosages of opioid medicines for at least 91 days, 37.64% of patients did not have a second consecutive high dose quarter due to death or stopping high dose use. Almost one in five patients who had a high dose quarter continued to have a high dose for the next three years (22.98%). Older patients, patients prescribed weak opioids and/or tramadol discontinued high dose use at a faster rate than younger patients. Conclusion Both high dose and long-term use were found to be associated with a prior prescribing of antidepressants before opioid use started, suggesting that in the U.K. psychological comorbidities are associated with continued and high dose opioid use. Further work is required to measure outcomes within these groups and to understand the care that these patients have already received. Most patients who start opioid medicines in the U.K. stop taking them in their first year of use. However, of those who continue use past two years, a large proportion continue for the full five year period. Similarly, only a small proportion of patients receive high dosages of opioid medicines but once this use is established, many patients have a high probability of continuation. Further work should be undertaken to facilitate effective review of these patients in practice.
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Altarifi, Ahmad. "EFFECTS OF MU OPIOID RECEPTOR AGONISTS ON INTRACRANIAL SELF-STIMULATION IN THE ABSENCE AND PRESENCE OF “PAIN” IN RATS." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/518.
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Pain is a significant health problem. Mu opioid receptor agonists are used clinically as analgesics, but their use is constrained by high abuse liability. Intracranial self-stimulation (ICSS) is a preclinical behavioral procedure that has been used to assess abuse potential of opioids, and drug-induced facilitation of ICSS is interpreted as an abuse-related effect. ICSS can also be used as a behavioral baseline to detect affective dimensions of pain. Specifically, pain-related depression of ICSS can model pain-related depression of behavior and mood, and drug-induced blockade of pain-related ICSS depression can serve as a measure of affective analgesia. This dissertation used mu agonists that vary in efficacy at the mu receptor (methadone> fentanyl> morphine> hydrocodone> buprenorphine> nalbuphine) and compared their effects on ICSS in the absence (phase one) or presence (phase 2) of pain. Adult male Sprague-Dawley rats were equipped with intracranial electrodes targeting the medial forebrain bundle and trained to lever press for brain stimulation. Different frequencies of stimulation maintained a frequency-dependent increase in ICSS rates, and permitted detection of both rate-increasing and rate-decreasing treatment effects. During phase 1, medium- and high-efficacy mu agonists produced initial rate-decreasing effects, followed by abuse-related rate-increasing effects at later time points. Repeated morphine administration produced tolerance to its own rate-decreasing effects, cross-tolerance to rate-decreasing effects of other mu agonists, and enhanced expression of rate-increasing effects. Low efficacy mu agonists only produced rate-increasing effects, which were enhanced after repeated morphine. These results suggest that previous opioid exposure increases expression of abuse-related facilitation of ICSS by mu agonists regardless of efficacy. During phase 2, intraperitoneal administration of lactic acid (1.8%) served as a noxious stimulus to depress ICSS. All mu agonists blocked acid-induced depression of ICSS at doses similar to those that facilitated ICSS in the absence of pain. A higher intensity noxious stimulus (5.6 % acid) produced further depression of ICSS and reduced the antinociceptive potency of both methadone and nalbuphine. Morphine antinociception was resistant to tolerance in the assay of acid-depressed ICSS. Overall, these results provide a basis for comparing determinants of abuse-related opioid effects in the absence of pain with their affective analgesic effects in the presence of pain.
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Kaplan, Rachel S. W. "The Rhetoric of the Opioid Crisis and Addiction to Prescription Pain Medicine." Thesis, Duquesne University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10787609.
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<p> In this historical moment, the United States is amidst an opioid crisis killing the young and the old; at least seventy-eight people die every day from an opioid-related overdose (Enomoto in Murthy III). Changing mindsets of the doctors who prescribe opioids is just as important as asking the patients who are prescribed them to demand an alternative medication. The different parties involved in the crisis all have a different agenda and their rhetorical bias is explored throughout this project. The pharmaceutical companies have launched aggressive marketing campaigns expressing the benefits of opioids and encouraged physicians to prescribe, the CDC has encouraged physicians to stop the overprescribing of opioids, and local police departments and hospitals are overwhelmed with overdoses. Future generations are now being affected by their parents’ opioid usage; one must stop and realize opioids are not the solution. Perhaps one of the most important implications from this project is to suggest all women, regardless of socioeconomic status and level of health literacy, be warned of the dangers opioids pose to her and any future children. When taking opioids during pregnancy, NAS is not the only concern; but also the larger concern is the complete dysfunction that opioid addiction brings and the personal chaos it creates for addicts and their families</p><p>
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Fisher, Deborah. "Opioid Withdrawal Signs and Symptoms in the Pediatric Patient during Opioid Tapering." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2719.
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Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as two to three days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time. A review of the literature revealed that the majority of the published studies used either a neonatal opioid assessment tool or no assessment tool. A subsequent international survey of pediatric providers found a wide range of opioid tapering practices and sporadic use of opioid withdrawal instruments to guide practice. Since tapering routines vary among practitioners, it is not uncommon to see signs and symptoms of opioid withdrawal. A prospective, descriptive study was conducted to describe the frequency of opioid withdrawal signs and symptoms and to identify factors associated with these opioid withdrawal signs and symptoms. The sample of 25 was drawn from all patients, ages 2 weeks to 21 years admitted to the Children’s Hospital of Richmond Pediatric Intensive Care Unit (PICU) and who have received continuous infusion or scheduled opioids for at least 5 days. Data collected included: opioid withdrawal score (WAT-1), opioid taper rate (total dose of opioid per day in morphine equivalents per kilogram [MEK]), pretaper peak MEK, pretaper cumulative MEK, number of days of opioid exposure prior to taper, and age. Out of 26 enrolled participants, only 9 (45%) had opioid withdrawal on any given day. In addition, there was limited variability in WAT-1 scores. The most common symptoms notes were diarrhea, vomit, sweat, and fever. For optimal opioid withdrawal assessments, clinicians should use a validated instrument such as the WAT-1 to measure for signs and symptoms of opioid withdrawal. Further research is indicated to examine risk factors for opioid withdrawal in children.
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Strobel, Spencer. "A pilot study of an emergency department's overdose education and naloxone distribution program." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21257.
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Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.<br>Opioid overdoses are increasing and several efforts are being made to reduce this problem. One potential solution is overdose education and naloxone distribution. Project ASSERT began distributing naloxone in conjunction with its overdose education program in 2009. Project ASSERT’s overdose education and naloxone distribution program trained opioid users in recognition, risk factors, and response to overdoses, as well as how to use nasal naloxone kits. Opioid users that had received overdose education only were compared with those that received overdose education and naloxone kits. The goal was to determine if there were any differences in occurrence of nonfatal overdoses, overdose response, illicit opioid use, and opioid agonist treatment.
This retrospective study involved phone-surveying patients from a hospital billing list. It was obtained through Project ASSERT and contained the names of patients that had received overdose education only or overdose education and naloxone distribution from January 2011 to February 2012. Questions were asked about the respondents’ naloxone kits, overdose history since their Project ASSERT visit, response to the last witnessed overdose, 30-day substance use, and overdose risk knowledge. Chi-square tests were used to compare the groups.
51 out of 415 eligible were successfully surveyed from March 2012 to October 2012. The surveys occurred on average 11.8 months after their Project ASSERT visit. 73% (37) had naloxone kits and most kept them where they lived (12). There were 9 successful overdose reversals reported. 76% (39) of the respondents did not overdose in the intervening period. There was no statistical difference between the two groups in overdose occurrence, 19% trained with naloxone versus 29% trained without naloxone (p=0.45). 16 out of 19 (84%) of the naloxone group properly responded to an overdose, whereas 3 out of 8 (38%) of those trained without naloxone properly responded (p=.03). There was no statistical difference in illicit opioid use (p=1.0) and opioid agonist treatment (p=.53), 36% of the group trained with naloxone versus 35% of the group trained without naloxone, and 49% of those trained with naloxone versus 36% of those trained without naloxone, respectively.
In studying the association between overdose education only and overdose education and naloxone distribution, it was found that there is not an increase in overdose and illicit opioid use. There also is no reduction in seeking for opioid agonist treatment. However, it was found that having naloxone kits does increase proper response to overdose. This is a promising result that could have an impact in reducing opioid overdose deaths.<br>2031-01-01
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Click, Ivy A., Jeri Ann Basden, Joy L. Bohannon, Heather Anderson, and Fred Tudiver. "Opioid Prescribing in Rural Family Practices: A Qualitative Study." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6366.
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Background: Rural Tennessee, especially rural East Tennessee has seen a dramatic increase in rates of controlled drug prescriptions and controlled drug overdose deaths in recent years. However, little is known about the individual decisions to prescribe or continue prescriptions with relation to addiction concerns. Objectives: The purpose of this study was to learn more about what factors lead to physicians’ prescribing control drugs for non-cancer pain through the use of focus groups. Methods: A qualitative study, using focus groups, in five family medicine clinics in East Tennessee and Southwest Virginia. The investigators used a semi-structured interview guide designed to facilitate group discussions about prescription drug abuse and misuse. Results: There were four main themes identified by the focus groups: (1) prescribers’ changing prescribing patterns over time; (2) factors that influence controlled drug prescribing; (3) use and barriers to using state prescription drug monitoring programs (PDMPs); (4) prescribing controlled drugs to women of childbearing age. Each theme had several subthemes. Conclusions: The balance between treating the patient's symptoms and causing potential harm is a challenge. The patient's pain cannot be ignored, but the potential harm of opioid therapy is not taken lightly. As the public health concern of prescription drug abuse in rural Appalachia continues to spread, prescribers are aware of their connection to the problem, and ultimately the solution.
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Pack, Robert P. "Opioid Use Disorder." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1335.
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Sundström, Görel. "Evolution of the Neuropeptide Y and Opioid Systems and their Genomic Regions." Doctoral thesis, Uppsala universitet, Farmakologi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-129513.
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Two whole genome duplications (2R) occurred early in vertebrate evolution. By using combined information from phylogenetic analyses and chromosomal location of genes, this thesis delineates the evolutionary history of two receptor-ligand systems that expanded by these large scale events. A third whole genome duplication (3R) took place in the teleost fish lineage and has also contributed to the complexity of the gene families. New members of neuropeptide Y (NPY) peptide and receptor families were generated in 2R and 3R. Evolutionary comparisons show that the ancestral teleost fish had four peptides; subsequently, differential losses of the peptide genes occurred. In zebrafish the peptides and receptors display differences in tissue distribution and have evolved binding preferences. In the frog Silurana tropicalis three peptides and six receptors werev identified, also displaying some differences in tissue distribution and receptor-ligand preferences. The findings in these experimental animals highlight both evolutionary conservation and lineage-specific features of the NPY system. The opioid system consists of four receptors and several peptides originating from four precursors. These results show that the receptor family was formed in 2R and 3R and that 2R together with one local duplication gave rise to the peptide family. The ancestral receptor and peptide genes were located on the same chromosome, suggesting coevolution. The Hox gene clusters, important in early development, provided the first strong evidence for 2R. Several neighboring gene families were analyzed and found to have expanded in 2R and 3R. In depth analyses of insulin-like growth factor binding protein (IGFBP) and voltage-gated sodium channel (SCN) gene families illustrates the importance of local duplications in combination with whole genome duplications in the formation of gene families. These findings provide additional strong evidence for two genome duplications in early vertebrate evolution and show that these events generated many new genes that could evolve new or more specialized functions.
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Troxler, Joyce. "Responding to the Opioid Crisis: Perspectives from Family Physicians." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6513.
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Chakraborty, Ujjwal. "OPIOID CODRUGS FOR PAIN MANAGEMENT." UKnowledge, 2011. http://uknowledge.uky.edu/chemistry_etds/2.
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Pain is an unpleasant sensory and emotional experience associated with actual or potential tissus damage or described in terms of such damage. Opioids are effective in treating moderate to severe pain, but opioid alone therapy is associated with several adverse effects, development of tolerance and addiction potential. One way to solve these problems is to administer opioids with adjuvant drugs. In this project several opioid molecules were combined with other adjuvant drugs in a single chemical entity to form a codrug.
A series of codrugs were prepared by conjugation of an opioid with S-(-)-nornicotine, ketamine, norketamine and gabapentin. Several of the synthesized codrugs were evaluated for analgesic activity in the rats after oral administration. Codeine-S-(-)- nornicotine, 3-O-acetylmorphine-S-(-)-nornicotine, and N-ethoxycarbonylgabapentincodeine codrugs showed greater effectiveness as well as prolonged pain management properties as compared to the parent drugs. Stabilities of several synthesized codrugs were studied in aqueous solutions from pH 1.3-7.4, in simulated gastrointestinal fluids, in rat plasma and in brain homogenate. Only the ester-linked codrugs showed sign of hydrolysis in different solutions. Carbamate-linked codrugs didn’t cleave under any hydrolytic condition. Pharmacokinetic study was performed on the following three codrugs: 3-O-acetylmorphine-S-(-)-nornicotine, N-acetylgabapentin-codeine, and N-ethoxycarbonylgabapentin- codeine. The carbamate linkage in 3-O-acetylmorphine-S-(-)- nornicotine codrug did not cleave in vivo to produce parent drugs. The ester linkage in N-acetylgabapentin- codeine codrug cleaved in vivo to produce codeine and N-acetylgabapentin, but N-acetylgabapentin did not undergo hydrolysis to produce gabapentin. The ester linkage in N-ethoxycarbonylgabapentin-codeine codrug hydrolyzed slowly in plasma to produce N-ethoxycarbonylgabapentin and codeine and then the carbamate linkage in N-ethoxycarbonylgabapentin hydrolyzed even slowly to produce gabapentin. Produced codeine also metabolized to generate some amount of morphine. Thus, the design and synthesis of an opiate and gabapentin codrug was achieved which was stable enough in the gastrointestinal tract, showed enhanced analgesic effects as compared to the physical mixture of the parent drugs, and also produced the two parent drugs in blood plasma.
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Towe, Aaron, Brent Baker, and Sarah Gach. "Assessing Knowledge, Behavior, and Attitudes of Family Medicine Residents toward Opioid Prescribing in Rural South Central Appalachia Residency Program." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/147.
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Intro: Opioids and their role in medicine, their use and abuse, have become a topic of intense scrutiny and interest over the last several years. Since 1999, the number of opioid overdose deaths has quadrupled, while the amount of prescription opioids sold in the U.S has increased by the same factor. Federal lawmakers, law enforcement, pharmaceutical companies, and investigative journalists have all become involved in what is often called “the opioid epidemic”, a stage where the issues of pain management, drug abuse, regulation, and autonomy are in seeming opposition. Physicians are uniquely positioned on this stage, both as healers and healthcare providers, professionals tasked with managing pain, preventing and treating addiction and overdose, and advocating for the needs of the population they serve. Paradoxically, issues related to pain management, addiction, and abuse are widely underrepresented in the educational curricula of most physicians’ formal training. This study aims to assess the attitudes and knowledge related to opioids in family medicine residents in a rural Appalachian residency program; as well as measure how these attitudes and knowledge change in the cohort after a limited course of education in issues surrounding opioid use, prescription, and abuse. It is our hope that this intervention will edify the residents, and they will feel more prepared to confront issues surrounding opioids as they move forward in their careers.
Methods:
Residents were given a ten-item questionnaire that assessed their knowledge of current Tennessee and Virginia state laws with regards to the prescription of opioids: The questionnaire also included an open-ended question where residents were asked to express how they felt about prescribing opioids: opinions they had formed, things they learned, things that they wished were different. Responses were uniquely identified by a paired code that abstracted the identity of the respondent from subsequent analysis. After anonymous collection of the completed questionnaire and open-ended response, a 30 minute didactic session was administered by the authors outlining common issues with opioid prescriptions, an overview of current TN and VA state law regarding opioid prescription, clinic policy, and discussion with residents of current thinking regarding best practices. The questionnaire was then administered again, responses were anonymously gathered and paired with their pre-didactic identification number. The responses were then analyzed to assess the impact of the didactic on understanding of current opioid prescribing law, and the open ended responses were examined for common themes in residents’ perception of prescribing opioids while in residency.
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Conclusions:
In general, short and focused didactic education regarding current state laws regarding opioid prescription appears to benefit residents understanding of how to prescribe opioids appropriately. Residents generally find the processes surrounding opioid prescription challenging, medically and emotionally, and are interested in more education about the topic.
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Pack, Robert P., Cheryl G. Healton, and Sandro Galea. "Maximizing Public Benefit From Opioid Settlement Resources." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/7838.
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The historic tobacco Master Settlement Agreement (MSA) between 46 State Attorneys General and the tobacco industry in 1999 had a range of consequences. It resulted in the closure of tobacco industry policy groups that undermined public health, sharply reduced tobacco marketing using cartoon characters (eg, Joe Camel) and paid product placement in television, film and other media, and created a new nonprofit foundation whose primary goal was to educate youth and prevent them from initiating tobacco use. It also resulted in more than $206 billion in resources being allocated to states, subject to appropriation by state legislators and governors. This enabled states to recoup the cost of medical and other treatment expenditures for tobacco‐related illness.1 However, by 2018, only 2.6% of the $206 billion in settlement and tobacco state taxes had been used for tobacco‐related harm mitigation or prevention.
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Flack, Gina R., Beth A. Fox, and Ivy A. Click. "Developing a Curriculum and Interprofessional Care Model to Address the Opioid Epidemic." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6377.
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Ghaly, Raouf George. "Acupuncture as an antiemetic in cancer chemotherapy and following opioid preanaesthetic medication." Thesis, Queen's University Belfast, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335957.
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Basden, Jeri Ann, Matthew Rafalski, Ivy A. Click, Fred Tudiver, and Heather Anderson. "Development of an Instrument to Assess Influences on Family Physician Opioid Therapy Prescribing." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6392.
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Rationale: Prescription drug abuse and misuse (PDA/M) is a significant problem in Central Appalachia and continues to grow. Since 2000, Tennessee has seen a 250% increase in prescription overdose deaths. Nationally, most prescription painkillers are prescribed by primary care doctors and dentists, rather than specialists. Objective: To develop and test a survey instrument aimed at understanding family physician knowledge, attitudes, and beliefs about opioid therapy prescribing. Design: Survey development. Setting: Survey questions were developed based on results of five focus groups held in primary care clinics in Northeast Tennessee and Southwest Virginia. Surveys were validated and tested by faculty and residents in three family medicine residency clinics in Northeast Tennessee. Participants: Survey questions were face validated for clarity and relevance by family physician attendings and third year residents (N=29). All faculty attendings and residents (N≈85) at the same family medicine residency clinics will be invited to complete the survey for psychometric testing. Main and Secondary Outcome Measures: Survey questions have been face validated for clarity and relevance. Data from the psychometric testing phase will be analyzed for internal consistency and inter-item correlations. Exploratory factor analysis will be used to identify underlying constructs. Results: Based on the results of the focus groups and physician expertise, a 51-item instrument was developed. Following face validation, wording was clarified on 25 questions, 3 questions were removed, and 5 questions were added, resulting in a 53-item instrument. Psychometric testing has not been completed at this time, but will be completed at the time of presentation. Conclusions: Researchers intend to use the findings to improve policies and practice guidelines for primary care clinics in the Appalachian region. Results will be used to design CME activities to decrease PDA/M and to help foster more effective and responsible prescribing of pain medication.
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Ramesh, Divya. "Elevating Endogenous Cannabinoids Reduces Opioid Withdrawal in Mice." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2661.
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Delta9-tetrahydrocannbinol (THC), the primary active constituent of Cannabis sativa, has long been known to reduce opioid withdrawal symptoms. Although THC produces most of its pharmacological actions through the activation of CB1 and CB2 cannabinoid receptors, the role these receptors play in reducing opioid withdrawal symptoms remains unknown. The endogenous cannabinoids, N-arachidonoylethanolamine (anandamide; AEA) and 2-arachidonylglycerol (2-AG), activate both cannabinoid receptors, but are rapidly metabolized by fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL), respectively. The objective of this dissertation was to test whether increasing AEA or 2-AG, via inhibition of their respective hydrolytic enzymes, reduces morphine withdrawal symptoms in in vivo and in vitro models of opiate dependence. Morphine-dependent ICR mice subjected to acute naloxone challenge or abrupt withdrawal (via pellet removal) reliably displayed a profound withdrawal syndrome, consisting of jumping, paw tremors, head shakes, diarrhea, and weight loss. THC and the MAGL inhibitor, JZL184 dose-dependently reduced the intensity of precipitated withdrawal measures through the activation of CB1 receptors. The FAAH inhibitor, PF-3845, reduced the intensity of a subset of precipitated signs through the activation of CB1 receptors, but did not ameliorate the incidence of diarrhea or weight loss. In the next set of experiments, MAGL inhibition dose-dependently reduced the intensity of all spontaneous withdrawal signs (i.e jumps, paw flutters, head shakes, weight loss and diarrhea) in a CB1 receptor dependent manner. However, FAAH inhibition reduced the intensity of head shakes and paw flutters, but did not affect other signs. Strikingly, a combination of low-dose JZL184 and high-dose PF-3845 reduced abrupt withdrawal signs in a manner similar to complete MAGL inhibition, which suggests potential therapeutic advantages of dual enzyme inhibition. This combination elevated appropriate eCB levels and caused moderate CB1 receptor desensitization, but did not affect receptor number in whole brain. Since MAGL, but not FAAH inhibition, blocked diarrhea during opioid withdrawal in vivo, we investigated whether inhibitors of each enzyme would differentially attenuate naloxone-precipitated contractions and secretion in morphine-dependent ilea in vitro. Both enzyme inhibitors attenuated the intensity of naloxone-induced contractions, and blocked naloxone-precipitated hypersecretion. Thus, these models offer useful tools for investigating in vitro end-ponts of withdrawal, but not for elucidating anti-diarrheal mechanism of these inhibitors.If targeting endocannabinoid catabolic enzymes is indeed a viable approach to treat other abuse disorders, it is important to know whether these inhibitors would themselves have abuse or dependence liability. In the final series of experiments we tested whether prolonged elevation of endocannabinoid leads to the development of cannabinoid dependence, based on the occurrence of somatic withdrawal signs upon challenge with rimonabant, a CB1 receptor antagonist. Repeated treatment with high doses, but not low doses, of JZL184 led to cannabinoid dependnece. These results indicate that the strategy of increasing endogenous cannabinoids through the inhibition of their catabolic enzymes represents a promising approach to ameliorate opioid withdrawal symptoms.
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Hull, Lynn. "Enzymatic Regulation of Opioid Antinociception and Tolerance." VCU Scholars Compass, 2009. http://scholarscompass.vcu.edu/etd/1875.
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ENZYMATIC REGULATION OF OPIOID ANTINOCICEPTION AND TOLERANCE By Lynn C. Hull, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2009 Director: William L. Dewey, Ph.D. Department of Pharmacology and Toxicology The involvement of kinases in opioid actions has long been established. The acute actions of opioids, through the Gi/Go G-proteins, cause the inhibition of adenylyl cyclase and therefore a decrease in protein kinase A (PKA) activation. Additionally, acute opioid administration may cause the G-protein to activate the phospholipase C (PLC)-mediated cascade leading to the activation of protein kinase C (PKC). The phosphorylation of the MOR which can lead to both desensitization by uncoupling of the G-protein coupled receptors (GPCRs) from the G-proteins and to internalization by recruitment of β-arrestins has long been identified as a key process in tolerance. Phosphorylation by PKA and PKC leads primarily to uncoupling of the receptor from the G-proteins. Phosphorylation of the receptor by G-protein coupled receptor kinase (GRK) leads to the recruitment of β-arrestins and internalization of the receptor. Many in vitro studies have come to the conclusion that GRK induced internalization plays a more central role in the tolerance to high efficacy opioids and a lesser role in low- and moderate-efficacy opioid tolerance. In fact it has been hypothesized that morphine, a moderate-efficacy opioid, causes no internalization at all, while the desensitization of the receptor via phosphorylation by PKA and PKC plays a more central role in low- and moderate-efficacy opioid tolerance. We sought to test these in vitro findings in an in vivo model of opioid tolerance. Animals were made tolerant to one of a number of opioids of varying efficacy (low-efficacy meperidine, moderate-efficacy morphine and fentanyl, and high-efficacy [D-Ala2, N-MePhe4, Gly-ol]-enkephalin (DAMGO)) over an 8 hour period and then were administered one of the kinases’ inhibitors. Tolerance reversal was determined by challenging these mice with the same opioids to which they were tolerant. Calcium is known to play an important role in the acute antinociceptive actions of opioids as well as in opioid tolerance. Therefore it is important to determine how opioids are affecting the regulation of intracellular calcium. Our laboratory has previously shown that Calcium Induced Calcium Release (CICR), the ryanodine receptor and intracellular microsomal Ca2+ pools all play a role in opioids’ actions. It is also well known that mammalian ADP-ribosyl cyclase, CD38’s, product cADPR acts on the ryanodine receptor to cause Ca2+ release into the intracellular space. We chemically and genetically altered CD38 and then tested the acute effect of morphine as well as what effect these treatments had on morphine tolerance to determine what role if any, that CD38 may play in the acute actions of morphine antinociception as well as in morphine tolerance. Together, studies focusing on the role of an ADP-ribosyl cyclase, CD38, and 3 separate kinases, PKA, PKC and GRK, in opioids’ actions were performed in order to better understand the roles of these enzymes’ pathways in the actions of opioid-induced antinociception and subsequent development of tolerance. It is hoped that the results herein add useful knowledge to the general understanding of this drug class, and will one day be of use in the development of future analgesics and in the clinical treatment of pain and reduction in tolerance.
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Whitmarsh, Sarah Friedman Barbara. "God's own medicine opiods, law and the health community /." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,2085.
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Thesis (M.A.)--University of North Carolina at Chapel Hill, 2008.<br>Title from electronic title page (viewed Feb. 17, 2009). "... in partial fulfillment of the requirements for the degree of Master of Arts in the School of Journalism and Mass Communication." Discipline: Journalism and Mass Communication; Department/School: Journalism and Mass Communication, School of.
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Jefferies, Stella Kiah. "Medication-Assisted Therapy Interventions and Prescription Opioid Misuse." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6223.
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Opioid drug misuse and dependence are a social and public health problem in the United States. Prescription opioid abuse and misuse have been associated with substantial morbidity and mortality rates as well as social and economic costs. The purpose of this project was to provide a systematic review of literature on the effectiveness of medication-assisted therapy interventions in addressing the problem of prescription opioid misuse in health care settings. The systematic review was completed through a literature search conducted across five electronic databases. The review was guided by the health belief model and eligible studies were rated using Johns Hopkins hierarchy of evidence. Fifteen peer-reviewed journal articles published from 2011 met the inclusion criteria and were reviewed in full. Of these, 14 were randomized controlled trials and 1 was a quasi-experimental study. The most commonly explored interventions were psychosocial interventions in conjunction with medications for opioid addiction. Review findings provided moderate evidence to support the effectiveness of psychosocial interventions in conjunction with medications in the treatment of opioid dependence, although the strength of the efficacy varied depending on the intervention provided. This project may advance nursing field by promoting provision of care to opioid dependent patients based on the best available evidence. Evidence-based care to patients with prescription opioid dependence will positively impact social change by improving the quality of life of patients, relieving caregivers of the burden of monitoring the addicted patients and saving millions of dollars spent in the criminal justice and health care systems.
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Pack, Robert P. "Public Health Initiatives to Address the Opioid Crisis." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7840.
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Discuss recommendations of the ASPPH Task Force on Public Health Initiatives to Address the Opioid Crisis. Learn from members of the academic public health community other/alternative public health initiatives to address the crisis.
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Obeng, Samuel. "Design, Synthesis, and Biological Screening of Selective Mu Opioid Receptor Ligands as Potential Treatments for Opioid Addiction." VCU Scholars Compass, 2017. http://scholarscompass.vcu.edu/etd/4771.
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Today, more Americans die each year because of drug overdoses than are killed in motor vehicle accidents. In fact, in 2015, more than 33,000 individuals died due to an overdose of heroin or prescription opioids. Sadly, 40-60 % of patients on current opioid addiction treatment medications relapse. Studies have shown that the addiction/abuse liability of opioids are abolished in mu opioid receptor (MOR) knock-out mice; this indicates that the addiction and abuse liability of opioids are mainly mediated through MOR. Utilizing the “message-address concept”, the our laboratory reported a novel non-peptide, reversible MOR selective ligand 17-cyclopropylmethyl-3,14β-dihydroxy-4,5α-epoxy-6α (isoquinoline-3-carboxamido)morphinan (NAQ). Molecular modeling and mutagenesis studies revealed that the selectivity of NAQ for MOR is because of the π-π stacking of the isoquinoline ring of NAQ with W318.
Therefore, other heterocyclic ring systems were explored to obtain a diverse library of compounds with similar or different molecular interactions and pharmacologic characteristics as NAQ. The newly designed compounds were indole analogs of 6α/β-naltrexamine. The compounds were synthesized and the affinity and selectivity for MOR determined using the radioligand binding assay while the functional activity at MOR was determined using the [35S]GTPγS binding assay. The indole analog of 6α-naltrexamine substituted at position 7 (compound 6) was found to be very potent and had the lowest efficacy in the [35S]GTPγS functional assay while the indole analog of 6β-naltrexamine substituted at position 2 (compound 10) was identified as a MOR agonist and had the greatest efficacy. In vivo studies were conducted using the warm-water immersion assay to find whether the synthesized compounds had antinociceptive effects and/or blocked the antinociceptive effects of morphine. Not surprisingly, compound 10 was identified as an opioid agonist while compound 6 almost completely blocked morphine’s antinociceptive effects. The opioid antagonist effect of compound 6 was found to be dose dependent with an AD50 of 2.39 mg/kg (0.46-12.47). An opioid withdrawal assay was conducted on compound 6 using morphine-pelleted mice. Compound 6 produced significantly less withdrawal symptoms at 50 mg/kg than naltrexone at 1 mg/kg. Therefore, compound 6 has the potential to be used in opioid addiction and withdrawal treatment.
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Paolozzi, Rodrigo Jesus. "Efeitos cardiorrespiratório, analgésico, sedativo e neuroendócrino de diferentes doses de tramadol em cães." Universidade do Oeste Paulista, 2009. http://bdtd.unoeste.br:8080/tede/handle/tede/232.
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Previous issue date: 2009-08-31<br>This double-blind study compared the cardiorespiratory, analgesic, sedative and neuroendocrine effects of different doses of tramadol administered intravenously (iv) in bitches, submitted to ovariohisterectomy. The animals were randomly assigned to three groups of 08 animals each, and treated with doses of tramadol in1mg kg-1 (GT1), 2mg kg-1 (GT2) and 4mg kg-1 (GT4). The pre-anesthetic medication administered was acepromazine (0.05 mg kg-1 iv), the anesthetic induction was performed with propofol (4mg kg-1 iv), and subsequent maintenance with general inhalatory anesthesia with isoflurane. The tramadol was administered 5 minutes after general inalatory anesthesia in all groups. Heart rate, respiratory rate, rectal temperature, systolic blood pressure, degree of analgesia and sedation, serum cortisol concentration and adverse effects were measured. In relation to analgesia degee there was not difference between the groups, excepted in the 3rd h after surgery, when GT4 group had lower pain scores than other groups. In the cardiorespiratory, mild alterations were observed, without difference between the groups. Sedation degree was not different between the groups, with lower scores until the 3rd h after to the end of surgery. The serum cortisol did not differ between the groups, although an increase was observed in the trans-operative period until the 3rd h after to the end of surgery. Vomit was observed in 50% of the dogs. It was concluded that the different doses of tramadol promoted satisfactory analgesia, with mild sedative and cardiorespiratory effects in bitches submitted to ovariohisterectomy.<br>Esse estudo duplo cego comparou os efeitos cardiorrespiratório, analgésico, sedativo e neuroendócrino de diferentes doses de tramadol administrado via intravenosa (iv) em cadelas, submetidas a ovariossalpingohisterectomia (OSH). Os animais foram distribuídos aleatoriamente em três grupos de 8 animais cada, sendo tratados com tramadol nas doses de 1mg kg-1 (GT1), 2mg kg-1 (GT2) e 4mg kg-1 (GT4). Na medicação pré-anestésica foi administrada acepromazina (0,05mg kg-1 iv), a indução anestésica foi realizada com propofol (4mg kg-1 iv), com posterior manutenção em anestesia geral inalatória, com isoflurano. O tramadol foi administrado 5 minutos após a estabilização da anestesia geral inalatória em todos os grupos. Foram mensurados: frequência cardíaca (FC), frequência respiratória (f), temperatura retal (T), pressão arterial sistólica (PAS), grau de analgesia, grau de sedação, concentração sérica de cortisol e efeitos adversos. Com relação ao escore de dor, não houve diferença entre grupos, com exceção da 3ª h pós-cirúrgica em que o GT4 apresentou escores inferiores em relação aos demais grupos. Na avaliação cardiorrespiratória mínimas alterações foram observadas, sem diferença entre os grupos. O cortisol não variou entre os grupos, porém foi observado aumento no período trans-operatório e às 3h após término da cirurgia. O grau de sedação não variou entre os grupos, com escores mais baixos até a 3ª h de avaliação pós-cirúrgica. Vômito foi observado em 50% dos animais do GT4. Conclui-se que as doses de tramadol empregadas nesse estudo induziram efeito analgésico adequado, com discreto efeito sedativo e mínimas alterações cardiorrespiratórias em cadelas submetidas à OSH.
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Pack, Robert P., Angela Hagaman, and A. McCaffrey. "A University-Community Response to the Opioid Epidemic." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7835.
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Inocencio, Timothy. "The Economic Burden of Opioid Poisoning in the United States and Determinants of Increased Costs in Opioid Poisoning." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2930.
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Introduction: Opioid poisoning has been rapidly increasing in the past decade, and has been driven in large part due to increases in opioid prescribing. This has been accompanied by intervention efforts aimed at preventing and reversing opioid poisoning through naloxone prescription programs. Current literature have not quantified the economic burden of opioid poisoning. Understanding this information can help inform these efforts and bring light to this growing problem. In addition understanding various determinants of increased costs can help to identify the types of populations more likely to have greater costs. Main Objectives: The objectives are 1) to quantify the economic burden of opioid poisoning, 2) to evaluate differences in costs, LOS, and in-hospital mortality depending on opioid type, 3) to identify opioids most likely to result in hospitalization for opioid-related ED visits and 4) to determine differences in the odds of admission to various hospital admission categories with respect to opioid type. Methods: A cost-of-illness approach was used to estimate the economic burden of opioid poisoning. Direct costs and prevalence estimates were obtained from nationally representative databases. Other sources of direct costs were obtained from the literature. Indirect costs were measured using the human capital method. Differences in costs, LOS, and in-hospital mortality were measured through generalized linear models using the National Inpatient Sample in 2009 from the Healthcare Cost and Utilization Project. The Drug Abuse Warning Network database was used to evaluate opioids most likely to result in hospitalization and to evaluate the likelihood of different opioids to cause admission into different types of hospital settings. Results: Opioid poisoning resulted in an economic burden approximately $20.4 billion dollars in 2009. Productivity losses were associated with 89% of this total. Direct medical costs were associated with $2.2 billion. Methadone was associated with the greatest inpatient costs and LOS, while heroin was associated with a greater likelihood of in-patient mortality compared to prescription opioids. Heroin, methadone, and morphine were associated with the greatest odds of hospitalization. Among admitted patients, methadone, morphine, and fentanyl were each associated with the greatest odds of ICU admission compared with other opioids. Conclusions: Opioid poisoning results in a significant economic burden to society. Costs, length of stay, in-patient mortality and the odds of hospitalization and admission type depend on the type of opioid involved. The results from this study can be used to inform policy efforts in providing interventions to reduce opioid poisoning and help focus efforts on populations at highest risk for increased costs.
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Pack, Robert P. "Opioid Use in Tennessee: Lessons Learned." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1342.
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Bhave, Sukhada. "THE ROLE OF ENTERIC GLIA IN OPIOID-INDUCED CONSTIPATION." VCU Scholars Compass, 2016. http://scholarscompass.vcu.edu/etd/4658.
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Morphine is one of the most widely used drugs for the treatment of pain but its clinical efficacy is limited by adverse effects including persistent constipation and colonic inflammation. Morphine-induced colonic inflammation is facilitated by microbial dysbiosis and bacterial translocation. In this study, we demonstrate that secondary inflammation and persistent constipation are modulated by enteric glia. In chronic morphine treated mice (75 mg morphine pellet/5 days), ATP-induced currents were significantly enhanced in enteric glia isolated from the mouse colon myenteric plexus. Chronic morphine resulted in significant disruption of the colonic epithelium and increased Il-1β in the myenteric plexus. The increase in ATP-induced currents, IL-1β expression and ATP release were also observed in isolated glia treated with lipopolysaccharide (LPS) consistent with bacterial translocation as a potential mediator of chronic morphine-induced inflammation. These effects of LPS were reversed by carbenoxolone, a connexin43 hemichannel blocker. In-vivo treatment with carbenoxolone (25 mg/kg) prevented 1) ATP-induced currents in enteric glia, 2)the decrease in neuronal density, and 3) colonic inflammation in chronic morphine treated mice. Inhibition of connexin43 in enteric glia also reversed morphine mediated decrease in gastrointestinal transit. These findings indicate that bacterial translocation-induced enteric glial activation and inflammation is a significant modulator of morphine-related constipation.
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Bennett, Ryan. "Association Tests of the Opioid Receptor System and Alcohol-Related Traits." VCU Scholars Compass, 2009. http://scholarscompass.vcu.edu/etd/1993.
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The opioid receptors and their endogenous ligands have long been implicated in a variety of traits including addiction, impulsive behaviors and substance dependence. Using phenotypic measurements collected from the IASPSAD, data from a latent class analysis and data from a SNP array and additional genotyping assays, association and regression tests were performed to determine the effects of common SNPs encoded in the genes of the opioid receptors and ligands on various traits relating to alcohol dependence. Although only one SNP can be reported as significant for substance dependence within alcoholics, there were a few results approaching significance that may offer some insight into variation within alcoholism.
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Kovelowski, Carl Joseph. "Supraspinal opioid delta receptor mediated antinociception: Supraspinal modulation of neuropathic pain." Diss., The University of Arizona, 1999. http://hdl.handle.net/10150/284132.
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The central objective of this dissertation focuses on the influence of supraspinal descending nociceptive inhibitory and facilitatory systems in the modulation of both nociceptive input and neuropathic pain states due to peripheral nerve injury. Opioid delta-mediated antinociception within the RVM was observed to modulate supraspinally organized nociceptive behavior to acute stimuli. Spinally organized nociceptive behavior was observed to be δ-mediated as well, but appeared to be stimulus intensity dependent. In addition, activation of δ-opioid receptors within the RVM elicited a dose-dependent antinociceptive effect to tonic forms of nociceptive input. Lesioning of the dorsal lateral funiculus (DLF) was observed to block both the antinociceptive effect of δ-opioid receptor activation in the RVM and attenuation of FLI in the lumbar spinal cord. Finally, concurrent administration of delta-opioid receptor selective agonists into the RVM and intrathecally elicited a synergistic antinociceptive effect to acute forms of nociceptive stimuli. Taken together, these studies presented in this dissertation suggest that activation of δ-opioid receptors within the RVM elicits an antinociceptive effect to both acute and tonic forms of nociceptive input by way of a descending nociceptive inhibitory pathway localized within the DLF. Increased levels, or activity, of supraspinal CCK may consequent to tonic activation of an on-cell descending nociceptive facilitatory system and the behavioral signs of neuropathic pain. For example, CCK levels in the caudal brainstem, when quantified by protein immunoassay, were higher in those animals that had received a ligation to the L5/L6 spinal nerves in comparison to sham operated animals. Administration of the CCK(B) receptor antagonist L365,260 into the RVM was observed to reverse both tactile allodynia and thermal hyperalgesia in L5/L6 ligated animals. In addition, administration of CCK-8 sulfate into the RVM was observed to produce tactile allodynia as well as thermal hyperalgesia, but to a lesser extent, in otherwise normal animals. Finally, a loss of morphine efficacy, when administered into the PAG, was restored by the administration of L365,260 into the RVM of L₅/L₆ ligated animals. Taken together, these studies presented in this dissertation suggest the involvement of a supraspinal descending nociceptive facilitatory influence in the modulation of neuropathic pain due to peripheral nerve injury.
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Pack, Robert P. "Lessons Learned a Decade into the Opioid Epidemic." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1338.
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Painter, Jacob T. "CHRONIC OPIOID USE IN FIBROMYALGIA SYNDROME: CHARACTERISTICS AND OUTCOMES." UKnowledge, 2012. http://uknowledge.uky.edu/pharmacy_etds/5.
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Fibromyalgia syndrome (FMS) is a chronic pain condition with significant societal and personal burdens of illness. Chronic opioid therapy in the treatment of chronic nonmalignant pain has increased drastically over the past decade. This is a worrisome trend in general, but specifically, given the pathophysiologic characteristics seen in fibromyalgia syndrome patients, the use of this class of medication deserves special scrutiny. Although the theoretical case against this therapy choice is strong, little empirical evidence exists. In order to supplement this literature, retrospective analysis methods are utilized to examine the association of state-, provider-, and patient level characteristics with the prevalence of chronic opioid use in this disease state. Data gathered through this analysis is then used to develop a propensity index for the identification of an appropriate control group for fibromyalgia patients, a task that has proven difficult in the literature to date. Using propensity stratification and matching techniques analysis of the impact of fibromyalgia, chronic opioid use, and the interaction of these two variables are undertaken.
Several key findings and updates to the understanding of chronic opioid use and fibromyalgia syndrome are reported. Wide geographic variation in chronic opioid utilization between states is seen. The role of diagnosing provider type in the rate of chronic opioid prescribing is significant and can be aggregated at various levels. Demographic characteristics, comorbid conditions, and concurrent medication use are all important associates of chronic opioid use in fibromyalgia syndrome. Additionally, chronic opioid use in fibromyalgia patients, independent of propensity to receive that therapy choice is a significant correlate with healthcare costs. A diagnosis of fibromyalgia is a statistically significant source of healthcare costs, though the clinical significance of its impact when compared to a closely matched control group is minimized. Despite the minimization of the role of this diagnosis the impact of the interaction of chronic opioid use with fibromyalgia, despite control for myriad regressors, is significant both statistically and clinically.
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Aschenbach, Lindsey. "SELECTIVE NON-PEPTIDE MU-OPIOID RECEPTOR ANTAGONIST: DESIGN, SYNTHESIS AND BIOLOGICAL STUDIES." VCU Scholars Compass, 2008. http://scholarscompass.vcu.edu/etd/1610.
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There are currently many opioid agonists available for clinical use as analgesics. However, many of these opioid agonists have notorious side effects including respiratory depression and may lead to addiction and dependence. Problems associated with these opioid agonists are determined to come from their interactions with the mu-opioid receptor. Opioid antagonists, such as naltrexone, have shown to aid in the treatment of opioid addiction. Although naltrexone has high affinity to the mu-opioid receptor, it lacks selectivity. Novel selective mu-opioid receptor antagonists were designed based on the identification of important pharmacophore elements in several known mu-opioid receptor agonists and antagonists. These compounds were synthesized and in vitro biological assays were conducted to determine their affinity to all three opioid receptors. Also, molecular modeling studines were conducted to help visualize the interactions between the mu-opioid receptor and these ligands. Finally, four lead compounds have been identified for further optimization.
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Leflore, Glenda. "Applying Clinical Guidelines to Curtail Opioid Overprescribing in Primary Care." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3699.
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The purpose of this scholarly project was to evaluate an evidence-based quality improvement program implemented in 2016 in a clinical practice setting to curtail overprescribing of opioids for noncancer pain management. In 2001, the National Pharmaceutical Council and The Joint Commission on Accreditation and Hospital Accreditation initiated a standard of practice for opioid use in noncancer pain management that resulted in opioid overprescribing and a 200% increase in opioid-related deaths and incalculable societal costs. Primary care providers including nurse practitioners issue the greatest number of opioid prescriptions; therefore, to address the problem of opioid overprescribing, the 2016 Centers for Disease Control and Prevention guidelines for opioid administration were implemented as a quality improvement program in a primary care setting with 10 providers. Lewin's change model was the vehicle for change and included an ongoing audit developed for tracking provider prescribing rates. The project sought to determine if adoption of the opioid administration guidelines reduced the prescribing rates in a clinical practice setting and thereby justify expanding the program to other primary clinic sites. A pre- post-single group comparison was conducted of prescribing rates from May 15, 2015 prior to implementing the guidelines and December 19, 2016 after the guidelines were in place. Analysis from t tests indicated a 41% (p < .01) reduction in prescribing rates. The project promotes positive social change through the decreased individual and societal cost of opioid- related deaths.
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Gade, Aravind. "THE ROLE OF α3β4* SUBTYPE OF NICOTINIC ACETYLCHOLINE RECEPTORS IN REVERSING OPIOID-INDUCED CONSTIPATION IN MICE". VCU Scholars Compass, 2015. http://scholarscompass.vcu.edu/etd/4037.
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Opioids are excellent pain relievers. A major side-effect of chronic opioid treatment is constipation whereas withdrawal following chronic exposure leads to diarrhea and increased gastrointestinal motility. These effects of chronic opioids are mediated by μ-opioid receptors expressed on enteric neurons. Previous studies have shown that chronic opioids enhance sensitivity to nicotine in the gastrointestinal tract. This suggested that prokinetic effects of nicotine mediated through the activation of nicotinic acetylcholine receptors (nAChRs) may be useful in reversing opioid-induced constipation. The goal of this dissertation was to investigate the nAChR subtype expressed on enteric neurons and their role in reversing opioid-induced constipation. The effect of nicotine on small intestinal transit and fecal pellet output were determined in-vivo in morphine-pelleted mice xiii (75 mg for 4 days). Nicotine-induced currents were measured by whole-cell voltage clamp in isolated adult mouse myenteric neurons treated with morphine over short term (10 mins) and long term (16-20 hrs). Following long term morphine exposure in-vivo (morphine pellet – 4 days), nicotine increased fecal pellet output, and enhanced small intestinal transit. The prokinetic effect of nicotine was not seen in placebo pelleted mice or after acute morphine (10 mg/kg, 30 min). Peak-amplitude of nicotine-induced inward currents in isolated neurons was also enhanced after long-term but not short term exposure to morphine. Nicotine-induced currents were inhibited by mecamylamine (10 μM) and α-conotoxin AUIB (3 μM), suggesting the expression of α3β4 subtype of nAChRs on enteric neurons. Conversely, NS3861, a partial agonist at α3β4 nAChR enhanced fecal pellet expulsion in a dose-dependent manner in chronic but not acute morphine treated mice. Overall, our findings suggest that the efficacy of nAChR agonists on enteric neurons is enhanced after chronic morphine exposure and activation of α3β4 subtype of nAChR reverses chronic but not acute morphine induced constipation. In conclusion, development of peripherally selective α3β4 partial agonists may be of therapeutic benefit in treatment of chronic opioid-induced constipation.
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Byrum, Mary Kristine. "America Addicted: The Relationship Between Dental School Education and the Opiate Prescribing Practices of Dentists in Ohio." Walsh University Honors Theses / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=walshhonors1524605016944778.
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Techapinyawat, Rheana. "The Evolution of Opium and Anesthesia: From the Ancient Sumerians to 1800s." The University of Arizona, 2018. http://hdl.handle.net/10150/626597.
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Quintans, Graciela. "Opioid peptides and the regulation of gonadotrophin release in post-partum beef cows and ewes." Thesis, University of Aberdeen, 1998. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU100680.
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Nutrition and suckling are known to be the most important factors affecting the length of the anovulatory post-partum period in beef cows. In sheep, nutrition and suckling are also important factors when ewes lamb during the season breeding, in more intensive production systems. A number of neurotransmitters have been proposed to be implicated in the activation of the GnRH pulse generator, which controls LH release. The aim of the present study was to investigate the role of the opioid peptides in the mediation of the effects of nutrition and suckling in both cows and ewes, during the post-partum period. Experiment 1 was designed to quantify the effects of post-partum energy intake on post-partum cows. Sixteen Aberdeen Angus and Simmental cows were arranged in a 2x2 factorial, with breed and energy intake as main factors. An opioid peptide antagonist receptor (naloxone) was administered in all cows in two periods of the post-partum (week 4 and 7) and in two consecutive days, in a high (0.8 mg/kg) or a low (0.4 mg/kg) dose. The overall response in LH to naloxone was low, and there was no significant treatment effects. However, a higher opiodergic tone at early, compared with at late, post-partum period was observed. Naloxone failed to evoke any prolactin response. Experiment 2 was designed to investigate the effects of nutrition and suckling intensity on the post-partum of ewes lambing during their breeding season, and to quantify these effects on the opioidergic tone. The experiment involved 40 ewes, in which 32 were assigned to two different diets and all of them suckled, and 80 ewes were assigned to one of these two diets and were weaned. All ewes were challenged with naloxone at day 12 post-lambing, with either a low (0.7 mg/kg) or a high (1.4 mg/kg) dose. Naloxone evoke an LH response in most of the animals, irrespective of the diet in which they were assigned. Naloxone also evoked an LH response in either suckled or weaned ewes. In the experiment 3, the interactive effect of nutrition and suckling on the post-partum interval and opioidergic tone was investigated. Sixteen Simmental cows were involved in a 2x2x2 factorial, with body condition at calving, post-partum energy intake and suckling intensity as main factors. At week 4, naloxone was administered (0.8 mg/kg) when a new follicular wave was detected and the follicle was in a growing stage, and it was also administered using the same dose, when that follicle achieved the dominant phase.
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Faria, António Manuel Augusto de. "Sedação em Medicina Dentária: boas práticas, factos e limites." Master's thesis, [s.n.], 2015. http://hdl.handle.net/10284/5270.
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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária<br>A escolha do tema para o presente trabalho de investigação, com vista à conclusão do
Mestrado Integrado em Medicina Dentária, tem por objectivo contribuir para, de uma
forma séria e clara, dar resposta a uma série de interrogações, ansiedades e situações
confusas entre membros da classe dos Médicos Dentistas no que diz respeito às
práticas de sedação durante tratamentos médico-dentários.
Este tema actual, especialmente no que ao panorama nacional diz respeito, tem vindo
a levantar no seio da classe diversas questões no que se refere às diferentes
abordagens e aos profissionais que as deverão praticar com segurança, nos diferentes
contextos.
Foi um objectivo, desde a génese do presente trabalho, que o mesmo contribuísse para
o estado da arte da Medicina Dentária portuguesa, ultrapassando a mera formalidade
curricular de conclusão de um ciclo de estudos de graduação, mas que permitisse
ainda um trabalho sólido a continuidade na investigação a desenvolver futuramente
nesta área do conhecimento médico.
Optou-se por dividir esta monografia em duas partes. Uma primeira de revisão teórica
dos conhecimentos e fundamentos inerentes à sedação, em que são revistos os
diferentes tipos de sedação existentes e disponíveis, os graus de sedação existentes, os
diversos fármacos e técnicas utilizadas, as indicações e contra-indicações e a sua
adequabilidade aos vários pacientes, de acordo com as suas especificidades.
Na segunda parte do trabalho, a ambição e o desejo de verificar os conhecimentos dos
Médicos Dentistas a exercer em Portugal, no que respeita ao uso de técnicas de
sedação na sua prática clínica, conduziu à realização de um trabalho de pesquisa com
preenchimento de inquéritos aos profissionais, abordando as técnicas, os
conhecimentos e a experiência. Todo este processo foi devidamente aprovado pela
Comissão de Ética da Universidade Fernando Pessoa.<br>The choice of the theme for this research paper, with the main goal to finish my MSc
in Dentistry, aims to contribute, in a serious and clean way, to give an answer to some
doubts, anxieties and some questions between members of Dentist class relating to
sedation practices during dentistry treatments.
Nowadays, especially concerned about the national scene, this theme has been raising
several questions with regard to different approaches and professionals who need to
practice safely in different contexts.
Since the beginning of this paper, it was a goal that this one contributed to the state of
the art of Portuguese Dentistry, going more far than the simple finish of a formal
curricular cycle of graduation’s studies. More than that, intents to be a solid and
consistent work to be continued, developing even more the research in this knowledge
area of medicine.
This work is divided in two parts. The first one is a theoretical review of knowledge
and fundamentals involved in sedation, where different types of available and existent
sedation techniques are reviewed. Besides that, intents to revise the several sedation
degrees, the most frequently used drugs and techniques, indications and
contraindications and their suitability to patients, according to their specificities.
On the second part of the paper, the ambition and desire to actually verify the
knowledge of Dentists about sedation techniques in Portugal and to know if a Dentist
recognizes how sedation techniques can be useful in the clinical practice, led to do a
research paper with filling out surveys to professionals, addressing the technical, the
knowledge and the experience. This whole process has been properly approved by the
Ethics Committee of Fernando Pessoa University.
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Reinecke, Bethany A. "Development of Bivalent Ligands Targeting the Putative Mu Opioid Receptor and Chemokine Receptor CXCR4 Heterodimer." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/5754.
Full textAbstract:
Human immunodeficiency virus (HIV) and opioid abuse have been described as synergistic epidemics. Pharmacologically, it has been found that opioids have the capacity to enhance HIV infection and replication. Research has shown that activation of the mu-opioid receptor (MOR) elevates the expression of the HIV-1 entry co-receptor CXCR4 on T-lymphocytes in the peripheral nervous system, thus allowing for enhanced viral entry and invasion. Although the exact mechanism for opioid modulation of CXCR4 expression and subsequent exacerbation of HIV is unknown, several hypotheses exist. One hypothesis is that MOR and CXCR4 are functionally interacting through the formation of a heterodimer. This hypothesis is supported by studies substantiating the ability for MOR and CXCR4 to form heterodimers with other GPCRs, and the finding that MOR and CXCR4 were co-expressed in several central and peripheral regions including immune cells. To test this hypothesis, a series of bivalent ligands containing both a mu opioid receptor (MOR) antagonist and a CXCR4 antagonist pharmacophore was designed and synthesized to understand the pharmacological role of the putative CXCR4-MOR heterodimer in opioid exacerbated HIV progression.
These bivalent ligands were evaluated for their binding and functional activities in radioligand binding, antibody binding, [35S]GTPγS, and calcium mobilization assays. In these assays, the bivalent ligands were shown to maintain binding and functional activities in both MOR and CXCR4 monoclonal cell lines. In addition, these bivalent ligands were evaluated for their ability to block HIV entry in a reverse transcriptase assay, and for their ability to inhibit morphine exacerbated HIV invasion in an LTR-luciferase assay. In these assays, the bivalent ligands were shown to inhibit HIV entry in a dose dependent manner. However, due to experimental limitations in our morphine exacerbated reporter system, the ability for the bivalent ligands to inhibit viral entry upon morphine co-exposure was not fully validated. Finally, molecular modeling approaches were utilized to visualize the putative binding modes of the bivalent ligands in a constructed MOR-CXCR4 heterodimer model.
Overall, these studies have provided a solid basis for the utility of bivalent ligands in studying MOR-CXCR4 interactions and their involvement in opioid potentiated HIV progression. Further studies are ongoing to optimize the bivalent ligands construct and explore new analyses to evaluate their ability to block opioid modulation of the virus.
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Gamage, Thomas. "Differential effects of endocannabinoid catabolic inhibitors on opioid withdrawal in mice." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/3293.
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The effects of cannabinoids in reducing somatic signs of opioid withdrawal have been known for some time. In morphine dependent rodents, opioid withdrawal following precipitation with the mu opioid antagonist naloxone elicits robust withdrawal behaviors including jumps, paw flutters, head shakes, diarrhea and weight loss. Delta-9-tetrahydrocannabinol has been shown to reduce this opioid withdrawal in mice via activation of the cannabinoid type-1 (CB1) receptor and recently it has been shown that inhibition of the catabolic enzymes for endocannabinoids also reduce somatic signs of opioid withdrawal. Specifically, inhibition the enzyme fatty acid amide hydrolase (FAAH), the catabolic enzyme for the endocannabinoid N-arachidonoylethanolamide (AEA; anandamide) or inhibition of the enzyme monoacylglycerol lipase (MAGL), the catabolic enzyme for the endocannabinoid 2-arachindonoylglycerol (2-AG) has been shown to reduce opioid withdrawal in mice. However, FAAH inhibition only reduced a subset of withdrawal signs in mice and full MAGL inhibition which maximally reduced somatic withdrawal signs has been shown to produce THC-like effects and dependence potential. Additionally, the effects of endocannabinoid catabolic inhibitors on other aspects of withdrawal, such as the negative motivational effects, are not known. The objectives of this dissertation were to 1) assess the efficacy of dual inhibition of FAAH and MAGL on somatic signs of opioid withdrawal and 2) determine whether these treatments would produce cannabimimetic effects (hypomotility, catalepsy, antinociception and hypothermia); 3) develop other behavioral assays of opioid withdrawal; and 4) determine if endocannabinoid catabolic inhibitors would reduce the acquisition of opioid withdrawal induced conditioned place avoidance (CPA) as a measure of the negative motivational consequences of opioid withdrawal. We found that full inhibition of FAAH with the selective inhibitor PF-3845 and partial inhibition of MAGL with the selective inhibitor JZL184 reduced withdrawal-related jumps and the expression of diarrhea to a greater degree than either inhibitor alone and these effects were shown to be CB1 mediated. Additionally, we tested the novel dual FAAH/MAGL inhibitor SA-57 which has greater potency at inhibiting FAAH over MAGL and found that it similarly reduced withdrawal signs at doses that only partially elevated 2-AG while fully elevating AEA; furthermore, SA-57 did not produce cannabimimetic effects at these doses. We next assessed the effects of morphine withdrawal in five behavioral assays: marble burying, novelty-induced hypophagia, the light/dark box, a novel procedure developed to assess “escape behavior” and the CPA procedure. From these studies we selected the CPA procedure to further evaluate the effects of endocannabinoid catabolic inhibitors to determine their ability to reduce the negative motivational aspect of opioid withdrawal. We found that naloxone (0.056 mg/kg) produced robust CPA in morphine-pelleted, but not placebo-pelleted, mice and that this dose elicited minimal somatic withdrawal signs. Morphine pretreatment was shown to block withdrawal CPA and withdrawal jumping in mice while clonidine only blocked withdrawal CPA and these served as positive controls. We found that THC, JZL184, and SA-57 significantly reduced the percentage of mice that jumped during the conditioning session, demonstrating that these treatments blocked the somatic signs of withdrawal. However, none of these treatments significantly affected acquisition of the withdrawal CPA. These studies suggest that dual inhibition of FAAH/MAGL has enhanced effects on attenuating withdrawal-related jumps and diarrhea, but not the negative motivational aspects of morphine withdrawal as inferred by the Pavlovian CPA experiments.
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Elbegdorj, Orgil. "DESIGN, SYNTHESES, AND BIOLOGICAL EVALUATION OF 14-N-SUBSTITUTED NALTREXONE DERIVATIVES AS OPIOID RECEPTOR LIGANDS." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/455.
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Opium, the dried resin obtained from the unripe seedpods of the poppy flower, has been used for medicinal and euphoric purposes since ancient times. Morphine, the main active ingredient of opium, and other clinically useful opioid analgesics all mediate their effects through activating the mu opioid receptor. Studies involving the mu opioid receptor knockout mice showed that the interaction with the mu opioid receptor is also responsible for many notorious side effects associated with these drugs including dependence and addiction. Therefore, selective antagonists for the mu opioid receptor are needed to study its function in drug abuse and addiction. Previously, based on molecular modeling studies and the “message-address” concept, a series of 14-O-substituted naltrexone derivatives were designed and synthesized. These compounds carried an ester-linked heteroaromatic substitution at the 14-position of naltrexone which was designed to interact with the putative “address” site, that was identified in the mu opioid receptor through molecular modeling studies. The lead compound of this series was determined to have a high affinity and selectivity for the mu opioid receptor. Because the 14-O-substituted naltrexone derivatives were not very stable, the ester linkage in these compounds was replaced by an amide one and a series of 14-N-substituted naltrexone derivatives were synthesized. The affinity and selectivity of these novel naltrexone derivatives were determined in a competitive radioligand binding assay. Interestingly, the 14-N-substituted naltrexone derivatives did not maintain the high selectivity of the 14-O-substituted series. It was hypothesized that the conformational constraint introduced by the amide linker was detrimental to the mu opioid receptor selectivity. Therefore, three 14-N-substituted naltrexone derivatives which carried more flexible linkages were synthesized and evaluated. The mu opioid receptor selectivity was not recovered by introducing rotational freedom into the linker. Some of these 14-N-substitued naltrexone derivatives were determined to be mu-kappa opioid receptor dual selective antagonists. Since the mu opioid receptor antagonists are effective at treating drug addiction, while growing evidence suggests that the kappa opioid receptor antagonists may be beneficial in lowering drug cravings, these novel mu-kappa opioid receptor dual selective antagonists may find unique clinical utility in the treatment of opioid dependence.
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Ouzounian, Nicole Marie. "A Phenomenological Research Study on the Treatment Experience of Opioid Addicts: Exploring the Intrapersonal and Interpersonal Conflicts that Opioid Addicts Face During the Treatment Process." Diss., NSUWorks, 2018. https://nsuworks.nova.edu/shss_dcar_etd/118.
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Opioid addiction is a physical, mental, and social issue. The insidious habits and behaviors acquired while living an addictive lifestyle are more powerful than human comprehension, and the training required to release these strongholds are extreme to say the least. Capturing the lived experiences of this process is needed to increase understanding of the development that leads to transformation from active addict to addict in recovery. This phenomenological research study on the treatment experience of opioid addicts used a qualitative approach to gain understanding of this phenomenon. For this study, 15 research participants were selected. Their ages ranged from 21 to 30-years-old and they all successfully completed an adult substance abuse treatment program. All participants must have been in active recovery for a minimum of one year. The central question for this study is: what are the intrapersonal and interpersonal conflicts opioid addicts are presented with during their treatment process? By means of conducting and analyzing interview questions and utilizing the conflict resolution theories of human motivation, social identity theory, coordinated management of meaning theory, and relative deprivation theory, this study revealed that the overall essence of the treatment experience is the journey of identity transformation from active addict to addict in recovery through conflict management. The need to manage conflict in five specific areas was uncovered. They include identity formation, stigma, interpersonal relationships, group structure, and conflict styles. The participants’ shared experiences provide insight into identifying conflicts that need to be managed and resolved so recovery is achieved and sustained.
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Healton, Cheryl, Robert Pack, and Sandro Galea. "The Opioid Crisis, Corporate Responsibility, and Lessons from the Tobacco Master Settlement Agreement." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7841.
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The opioid crisis has accounted for 770 000 deaths in the United States over the past 20 years, a number approximately equal to the first 20 years of the AIDS epidemic.1 A substantial portion of these deaths were the direct result of overprescription of opioids, and many others were caused by former prescription opioid users migrating to less expensive and easier to obtain heroin and synthetic opioids, such as fentanyl and its analogues. The opioid crisis has contributed to the decline in US overall life expectancy for 3 consecutive years; the first 3 year-on-year decline in US life expectancy since the 1918 flu pandemic.
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Crabtree, Brian, J. Lyle Bootman, Cynthia J. Boyle, Patricia Chase, Peggy Piascik, and Lucinda L. Maine. "Aligning the AACP Strategic Engagement Agenda with Key Federal Priorities in Health: Report of the 2016-17 Argus Commission." AMER ASSOC COLL PHARMACY, 2017. http://hdl.handle.net/10150/626251.
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The Argus Commission identified three major federal priorities related to health care, including the precision medicine initiative, the Cancer Moonshot and the opioid abuse epidemic. Current activities at the federal level were summarized and an analysis of activities within the profession, and academic pharmacy specifically, was prepared. The implications for pharmacy education, research and practice are compelling in all three areas. Recommendations, suggestions and two policy statements aim to optimize the attention to these priorities by the academy. Further, aligning the AACP Strategic Engagement agenda with the opportunities and threats acknowledged in the analysis is essential.
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Hagemeier, Nicholas E., Arsham Alamian, Matthew M. Murawski, Heather Flippin, Elizabeth J. Hagy, and Robert P. Pack. "Correlates of Prescription Opioid Legitimacy Judgments Among Community Pharmacists." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1321.
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Background: Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. Objective: To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. Methods: A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. Results: Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). Conclusions: Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse.
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SILVA, NETO Jairo de Macedo Lins e. "Avaliação do protocolo anestésico xilazina, quetamina e remifentanil em cadelas submetidas à ovário- salpingo-histerectomia através da eletrocardiografia." Universidade Federal Rural de Pernambuco, 2008. http://www.tede2.ufrpe.br:8080/tede2/handle/tede2/5683.
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Previous issue date: 2008-02-29<br>Several anesthesic protocols aiming to reduce undisirable haemodinamics effects, allowing safetier return with minimal side effects to patient. Thus, the objective of this study was to evaluate the possible changes in vital parameters related to ECG, heart rate and body temperature in bitches pre-treated with atropine, anesthetized with ketamine and xylazine, associated or not to different doses on a continuous infusion of remifentanil. It was used 15 clinical healthy bitches, distributed acoording to experimental groups: G1= ketamine+ xylazine; G2= ketamine + xylazine + continuous remifentanil infusio(0,125 g/Kg/min); G3 = ketamine + xylazine + continuous remifentanil infusion (0,25 g/Kg/min). The variable measurement was accomplished before pre-anesthesia (M0), simultaneously to skin incision (M1), during the closing of right ovarian pedicle (M2), during the occlusion of the uterine stump (M3) and half for finish of the skin synthesis (M4). Data showed a sudden increasing on average and standard deviation of cardiac frequency in all groups at M1 (178.6 20.6), having decreasing, although with tachycardia tendency until M4 (157.3 18.3). Such M1 elevation is correspondent to surgical cut moment, suggesting the biggest nociceptive moment, following by right pedicle closing M2, (176.0 15.2). It was not observed apnea on animals, just an considerable repiratory decreasing on six animals (6/15) being one of them (1/5) on G1, thre animals (3/5) on G2 and two animals (2/5) on G3. The corporal temperature values measured by rectum did not showed biological significant among groups, keeping these averages compatibles qith physiological parameters for specie. According to the resultspresented one can suggest that the increase in T wave may be related to electrolyte imbalance, and disrritmia heart, being observed framework of hypoxemia. Further studies with a larger number of animals may confirm the efficiency of the anesthetic protocol using atropine, xylazine, ketamine associated with continuous infusion for remifentanil under the effective control of pain.<br>Os diversos protocolos anestésicos visam abreviar os efeitos hemodinâmicos indesejáveis, proporcionando um retorno mais seguro, com os mínimos efeitos colaterais para o paciente. Dessa forma, objetivou-se com este trabalho avaliar as possíveis alterações de parâmetros vitais relacionadas à eletrocardiografia, freqüência respiratória e temperatura corporal em cadelas pré-tratadas com atropina, anestesiadas com quetamina e xilazina, associadas ou não a diferentes doses de remifentanil sob infusão contínua. Para tanto, foram utilizadas 15 cadelas clinicamente sadias, distribuídas de acordo com os grupos experimentais: G1 = quetamina + xilazina ; G2 = quetamina + xilazina + infusão contínua com remifentanil (0,125μg/Kg/min); G3 = quetamina+ xilazina + infusão contínua com remifentanil (0,25μg/Kg/min). As mensurações das variáveis foram realizadas antes da pré-anestesia (M0), simultaneamente à incisão da pele (M1), durante a ligadura do pedículo ovariano direito (M2), durante a ligadura do coto uterino (M3) e na metade do término da síntese cutânea (M4). Os resultados apresentaram aumento nas médias e desvio padrão na freqüência cardíaca em todos os grupos no M1 (178,6±20,6), sendo posteriormente decrescente, porém, com tendência à taquicardia até M4 (157,3±18,3). Tal elevação em M1, corresponde ao momento de incisão cirúrgica, sugerindo o momento de maior estímulo nociceptivo, seguido da ligadura do pedículo direito (M2, 176,0±15,2). Não se observou apnéia em nenhum dos animais, apenas queda considerável da freqüência respiratória em seis animais (6/15), sendo um animal (1/5) no G1, três animais (3/5) no G2 e dois animais (2/5) no G3. Os valores da temperatura corporal,mensuradas via retal, não apresentaram diferenças biologicamente significativa entre os grupos, mantendo suas médias dentro dos parâmetros fisiológicos para espécie. De acordo com os resultados apresentados pode-se sugerir que o aumento da onda T pode estar relacionado a desequilíbrio eletrolítico, além de disrritmia cardíaca, sendo observado quadro de hipoxemia. Estudos posteriores com um maior número de animais poderão confirmar a eficiência do protocolo anestésico utilizando atropina, xilazina, quetamina associadas ao remifentanil sob infusão contínua para o efetivo controle da dor.
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Neves, Celso Sawaya. "Administração peridural de morfina ou tramadol em cães: efeito analgésico e cardiorespiratório." Universidade do Oeste Paulista, 2009. http://bdtd.unoeste.br:8080/tede/handle/tede/227.
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Previous issue date: 2009-08-26<br>This double-blind study compared the analgesic and cardiopulmonary effects of the peridural morphine or tramadol in bitches submitted to ovariohisterectomy. Dogs were randomly assigned to three groups of 08 animals each and received morphine (0.1mg.kg-1 GM), tramadol (2mg kg-1 GT) or a saline placebo (0.2ml.kg-1 GS). Pre-anaesthetic medication was acepromazine (0.05mg kg-1 iv). Anaesthesia was induced with propofol (4mg kg-1 iv) and maintained with isoflurane. Heart and respiratory rates, systolic arterial pressure, rectal temperature, arterial blood gases and analgesia degree were evaluated. The quality and duration of postoperative pain relief did not differ between morphine or tramadol treatments. Rescue analgesia was administered to 06 dogs in the GS and just to 01 dog in the GT. During anesthesia, mild respiratory and cardiovascular depression was reported. It was concluded that peridural administration of morphine or tramadol is a safe and effective method to inducing long-lasting analgesia in dogs submitted to ovariohysterectomy.<br>Objetivou-se com este estudo duplo cego avaliar o efeito analgésico e cardiorrespiratório da morfina ou tramadol quando utilizados via peridural, em cadelas submetidas à ovariossalpingohisterectomia (OSH). Vinte e quatro cadelas foram tranqüilizadas com acepromazina (0,05mg kg-1 iv), seguindo-se indução e manutenção anestésicas com propofol (4mg kg-1 iv) e isofluorano, respectivamente. Os animais foram distribuídos em três grupos, com 08 animais em cada: GM, GT e GS, tratados com morfina (0,1mg kg-1), tramadol (2mg kg-1) ou solução salina (0,2ml kg-1), respectivamente pela via peridural lombo-sacra. Foram mensurados: freqüências cardíaca (FC) e respiratória (f), pressão arterial sistólica (PAS), variáveis hemogasométricas, e temperatura retal (T) durante os períodos pré e trans-cirúrgico. O grau de analgesia, mensurado mediante escala descritiva numérica, bem como a necessidade de analgesia resgate foram avaliadas nas primeiras 24 horas após a cirurgia. A estatística foi realizada mediante análise de variância com aplicação do teste de Tukey, ao nível de 5% de significância. Resultados analgésicos semelhantes foram obtidos com o uso de morfina ou tramadol, com observação de analgesia de longa duração. Analgesia resgate foi necessária em 06 animais tratados com solução salina e 01 animal tratado com tramadol. Mínimas alterações cardiorrespiratórias foram observadas durante o procedimento anestésico. Conclui-se que tanto a administração peridural de morfina quanto a de tramadol resultam em analgesia adequada e de longa duração, com mínimos efeitos cardiorrespiratórios em cadelas submetidas à OSH.
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Kren, Matthew. "The Role of Gonadal Hormones on Opioid Receptor Protein Density in Arthritic Rats." VCU Scholars Compass, 2006. http://hdl.handle.net/10156/1966.
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