Hintergrund/Zielsetzung: In klinischen Studien zeigte Tapentadol retard in der Schmerzbehandlung im Vergleich zu anderen starken Opioiden ein besseres gastrointestinales Verträglichkeitsprofil. In ...der vorliegenden Analyse wurden Tapentadol retard und klassische retardierte WHO-III-Opioide in der Versorgungsrealität verglichen.Methode: Retrospektive Kohortenstudie (Matched-Pair-Ansatz) anonymisierter Krankenkassendaten von Patienten mit chronischen Rückenschmerzen, denen nach Vortherapie mit WHO-I/II-Analgetika starke Opioide verordnet wurden. Die Datenauswertung erfolgte ausgehend vom Datum der Indexverordnung im Jahr 2015 über einen Nachbetrachtungszeitraum von maximal zwei Jahren. Der primäre Analyseparameter war die Verordnung von Laxanzien.Ergebnisse: In die Analyse konnten die Daten von 227 Patienten pro Kohorte einbezogen werden. Unter Tapentadol retard wurde im Vergleich zu WHO-III-Opioiden signifikant weniger Patienten Laxanzien verordnet (20,3% vs. 37%; p < 0,0001). Die Dosierung der Laxanzien war signifikant geringer in der Tapentadol-Kohorte (26,4 vs. 82,5 durchschnittliche definierte Tagesdosen; p < 0,0001). Auch unter Langzeitbehandlung wurde ein signifikanter Unterschied in der Laxanzienverordnung beobachtet (27,7% Tapentadol-retard-Patienten vs. 50% Patienten mit WHO-III-Opioiden; p = 0,0029).Schlussfolgerung: Die bessere gastrointestinale Verträglichkeit von Tapentadol retard in der Behandlung chronischer Schmerzen, die bereits in klinischen Studien und Anwendungsbeobachtungen gezeigt wurde, konnte indirekt in der Versorgungsrealität bestätigt werden.Schlüsselwörter: Chronischer Rückenschmerz, gastrointestinale Verträglichkeit, Tapentadol, Versorgungsforschung, WHO-III-OpioideEingereicht am 19.11.2021 - Revision akzeptiert am 25.1.2022
AimIn paediatrics drugs are prescribed as mg/kg doses to facilitate accurate dosing. Anecdotally, some drugs are prescribed in such a way that the volume to be given is difficult to measure which may ...lead to inaccuracies and potential for error. Locally, errors have been reported where there has been a misunderstanding of the required dose, especially when decimal points are involved. This audit aimed to evaluate doses prescribed for in-patient children and evaluate whether they can be measured using the printed markings of one oral syringe.MethodData were collected for paediatric in-patients between 16th February and 27th March 2015 from paper drug charts and an electronic prescribing system depending which was in use in each area. Specific data on patient age, weight and prescribed dose were collected. Volumes were then calculated using the enteral products kept in the Trust formulary, including unlicensed specials. The prescribed volumes were reviewed against the Medicina Home® enteral syringes to see if they were measurable on the printed graduations of one oral syringe (in line with local dispensing standards). If they could not be measured, the percentage dose rounding required was calculated to see if doses could be rounded. A judgement was then made as to whether this was within an acceptable safe dose limit.ResultsData for 560 individual medication orders for oral medicine were collected, 257 from electronic prescribing and 303 from paper charts. Of these 457 were liquid doses, 103 were from products only available as tablets or capsules. Of the 257 electronically prescribed doses, 61 (24%) were not measurable. Of the 303 paper chart doses, 57 (19%) were not measurable.Of the 457 liquid doses 77 only needed up to 4% dose adjustment to become measurable. A further 10 doses required up to 9% dose adjustment.Drugs that were frequently prescribed as non-measurable doses were: diazepam, alimemazine, chloral hydrate, azithromycin, metronidazole, paracetamol & ibuprofen.Some doses were not measurable from tablets and no liquid is available in the Trust: clonidine, omeprazole, lansoprazole, nifedipine SR.19/560 (3.4%) of medication orders required a dose to be measured to two decimal places: diazepam, morphine, clonazepam, furosemide, spironolactone, chloral hydrate, ranitidine, chlorothiazide, azithromycin, erythromycin.ConclusionThis audit has shown that by prescribing accurately as mg/kg without any dose rounding almost a quarter of doses cannot be measured accurately. Only a small dose adjustment is required to make the doses measurable. The current electronic prescribing system in use does not appear to have any automatic rounding, indeed the prevalence of difficult to measure doses was slightly worse (although not statistically significant, p value 0.19, Chi squared test), possibly because the prescriber doesn't “sense check” what they are prescribing as it is automated. Particular drugs with unusual strengths are often implicated in having harder to measure doses. Consideration should be made to round doses when prescribing and to add information regarding the strength of liquids available in local clinical guidelines.
More than one in ten of the adult population were prescribed powerful opioid pain medications in 2017-2018, a major review by Public Health England (PHE) found.
Das klinische Spektrum der Obstipation ist breit. Für die Diagnose sind die Beschwerden des Patienten wichtiger als objektive Daten wie die Stuhlfrequenz. Deshalb heißt es, die Symptome genau zu ...erfragen, denn sie geben oft schon Hinweise auf eine geeignete Therapie.
We describe the design, synthesis, and opioid activity of fluoroalkene (Tyr1-ψ(Z)CF=CH-Gly2) and trifluoroethylamine (Tyr1-ψ(S)/(R)-CF3CH-NH-Gly2) analogues of the endogenous opioid neuropeptide, ...Leu-enkephalin. The fluoroalkene peptidomimetic exhibited low nanomolar functional activity (5.0±2nm and 60±15nm for delta- and µ-opioid receptors, respectively) with a µ/delta-selectivity ratio that mimics that of the natural peptide. However, the trifluoroethylamine peptidomimetics, irrespective of stereochemistry, did not activate the opioid receptors, which suggest that bulky CF3 substituents are not tolerated at this position.
PDF
