This document summarizes guidelines for prescribing opioids to manage chronic pain. It discusses the high prevalence and economic impact of chronic pain, as well as barriers physicians face in treating it. While opioids can provide pain relief, they carry risks of adverse effects, addiction, and overdose. The guidelines recommend developing a comprehensive treatment plan, trying non-opioid options first, carefully selecting and titrating opioid doses, monitoring patients for signs of misuse, and using treatment agreements to promote safe prescribing. The goal is to improve patients' function and quality of life while minimizing risks from long-term opioid therapy.
Medication Adherence , setting up directions .. Ahmed Nouri
presenting the terminology of adherence, statistics of non-adherence and its impact, why do patients have difficulty with treatment, how to measure and how to improve the adherence, in addition to the role of the pharmacist in improving adherence.
It is a health specialty, which describes the activities and services of the clinical pharmacist to develop and promote the rational and appropriate use of medicinal products and devices.
Clinical Pharmacy includes all the services performed by pharmacists practising in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used.
The term "clinical" does not necessarily imply an activity implemented in a hospital setting. It describes that the type of activity is related to the health of the patient(s). This implies that community pharmacists and hospital pharmacists both can perform clinical pharmacy activities
Medication Adherence , setting up directions .. Ahmed Nouri
presenting the terminology of adherence, statistics of non-adherence and its impact, why do patients have difficulty with treatment, how to measure and how to improve the adherence, in addition to the role of the pharmacist in improving adherence.
It is a health specialty, which describes the activities and services of the clinical pharmacist to develop and promote the rational and appropriate use of medicinal products and devices.
Clinical Pharmacy includes all the services performed by pharmacists practising in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used.
The term "clinical" does not necessarily imply an activity implemented in a hospital setting. It describes that the type of activity is related to the health of the patient(s). This implies that community pharmacists and hospital pharmacists both can perform clinical pharmacy activities
This power point is my attempt to address the common yet serious issue of Polypharmacy.
Polypharmacy in elderly is a necessary evil. Although it is not always inappropriate, but the “inappropriateness” should be judged on a case to case basis.
Necessary tools should be used to avoid it.
And deprescribing is recommended to correct it as soon as it is labeled as a case of “inappropriate polypharmacy”.
Describes in detail the concept of compliance to therapeutic regimen, difference between adherence and compliance, factors which influence compliance, methods of assessing, reasons for non-compliance and strategies to improve compliance to the therapy.
Patient medication adherence, Medication adherence, Causes of medication non-adherence, Problems linked with Medication Non-adherence, Factors affecting medication adherence, Patient related factors, Social and Economic factor, Disease related factor, Health care provider related factors, Therapy related factors, pharmacist role in the medication adherence, role of pharmacist in the medication adherence, monitoring of patient medication adherence, Direct method, Indirect method
it is a very important topic in healthcare management. Pharmacist being the end point of contact for medicine use, he/she must be very careful in explaining the same to the patients while dispensing.
This power point is my attempt to address the common yet serious issue of Polypharmacy.
Polypharmacy in elderly is a necessary evil. Although it is not always inappropriate, but the “inappropriateness” should be judged on a case to case basis.
Necessary tools should be used to avoid it.
And deprescribing is recommended to correct it as soon as it is labeled as a case of “inappropriate polypharmacy”.
Describes in detail the concept of compliance to therapeutic regimen, difference between adherence and compliance, factors which influence compliance, methods of assessing, reasons for non-compliance and strategies to improve compliance to the therapy.
Patient medication adherence, Medication adherence, Causes of medication non-adherence, Problems linked with Medication Non-adherence, Factors affecting medication adherence, Patient related factors, Social and Economic factor, Disease related factor, Health care provider related factors, Therapy related factors, pharmacist role in the medication adherence, role of pharmacist in the medication adherence, monitoring of patient medication adherence, Direct method, Indirect method
it is a very important topic in healthcare management. Pharmacist being the end point of contact for medicine use, he/she must be very careful in explaining the same to the patients while dispensing.
Surfactant-modified native soil in the treatment of oil field (Nimr) produc...mahfoodhshuely
In this study, we investigated the possibility to use surfactant-modified and unmodified native
sand (Oman) for the treatment of oil field (Nimr) produced water.
A tool presented at the Helping the Helpers workshop at LiveOn NY's 26th Annual Conference on the Transformation of Aging. The focus of the workshop was on how to combat and manage stress for those in the helping professions. This tool helps individuals assess their current quality of life as it relates to their work.
PTSD, stress, secondary trauma (vicarious trauma) and compassion fatigue represent a serious problem for people who care for, hear about or witness the intense suffering of others. Ultimately, this can lead to burnout. Several professions are at high risk including physicians, attorneys, nurses, psychologists, counselors, social workers, hospice workers, adult and child protective service workers. Those who care for people in nursing homes and those who care for patients at home are also at risk. Families who care for suffering relatives are particularly vulnerable to these problems.
This information outlines 14 steps that can be taken to increase resilience to this form of stress. Two effective approaches are underscored for desensitizing traumatic stress and calming the emotional midbrain. The presentation provides links to information that explains the nature of the problem and offers practical self-help interventions.
The Physiology of Addiction - February 2012Dawn Farm
"The Physiology of Addiction" was presented on Tuesday February 21, 2012, by Dr. Carl Christensen, MD, PhD, FACOG, CRMO, ABAM. This program explores the differences in neurochemistry between the addicted brain and the normal brain, the progression of physiological changes that occur in people with alcohol/other drug addiction, the mechanisms of physiologic tolerance and withdrawal, and the effects of treatment on the addicted brain. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
National Drug Early Warning (NDEWS) webinar: A more dangerous heroin: Emergin...Dan Ciccarone
This presentation, to an international web audience, was presented alongside one by Dr Wilson Compton, Deputy Director of the National Institute on Drug Abuse. Sponsored by NDEWS, it explores the structural reasons for the emerging heroin overdose epidemic and ways to address it.
A lecture given to nurse practitioners, physician assistants and others on pain management. The aim of the talk is to review:
1- the principles of effective pain management;
2- the knowledge and/or resources to assist in indentifying patients at high risk for substance abuse, and
3- the importance of counseling patients about the side effects, addictive nature and proper storage and disposal of prescription medications.
*Disclaimer: Case presentation is made up of a combination of cases, and does not reflect the case of any one particular patient.
Wsam Presentation For Opiate GuidelinesJKRotchford
CME presentation at WSMA annual meeting. Problematic opioid use, questioning the concept of "pseudo-addiction", seeing chemical dependency as somewhere well along the continuum of problematic opioid use.
Unnecesary Medication Use in Long Term Care FacilitesDebbie Ohl
Meds are a key component in the clinical process.
The guidelines are intended to insure medication use is of value and necessary. T
Significant emphasis is placed on preventing and recognizing adverse drug reactions ASAP.
Consequently, surveyors will expect to see:
Rationale for use, Parameters for monitoring
Prompt recognition and evaluation of new onset problems and conditions worsening
Consideration for dose reduction and discontinuance as appropriate.
Pain And Dependence Screening For Addiction In A Pain Setting Dr Steve Gi...epicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Steve Gilbert and Dr Alex Baldaccino. In this talk, they discuss the assessment and screening of patients in the pain clinic for evidence of drug dependence.
www.nbpa.org.uk
The Psychology and Neurology of Substance Related DisordersRaymond Zakhari
New York City Chapter Men In Nursing Conference 2016 an overview (includes specific information regarding marijuana, stimulants, hallucinogens, depressants)
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
1. THE HIGHS AND LOWS OF OPIATES A REVIEW OF THE CPSO GUIDELINES Leon Rivlin MD, CCFP (EM)
2. OBJECTIVES Evaluate opioids in the management of chronic pain Define an approach to the recognition of opioid misuse in the chronic pain patient Evaluate protocols for safe and effective prescribing of opioids in chronic pain Discuss the pitfalls of opiate management
3. WHY IS OPIATE MANAGEMENT SUCH A GREAT CONCERN ? WHY IS CHRONIC PAIN IMPORTANT?
4. Canadian National Pain Study 2002 Chronic pain is present in 22 – 39% adults #1 reason for chronic pain: arthritic conditions Prevalence of pain increases with aging Only 36% of patients felt that their pain was effectively Rx 68% of MD’s believed that chronic pain could be treated more effectively Moulin D., PR&M, 2002,2003
5. ECONOMIC IMPACT 13% of workers lose a mean of 4.6 hours /wk of productive work time due to common pain conditions Costs to industry $6.2 B/yr (US) 76 % due to reduced performance at work Costs of depression to industry $31 B/yr Equal to impact of CV disease, or Cancer Stewart et al. JAMA 2003
6. BARRIERS for PHYSICIANSto TREATING CHRONIC PAIN Limited training in medical schools Insufficient knowledge and understanding Disease centred model of care does not prioritize the management of pain Biopsychosocial model of pain underutilized Fears about regulatory bodies Biases and fears about opioid use & addiction
7. BIASIS & FEARS ABOUT OPIOID ANALGESICS 2004 DATA Study of Wisconsin physicians' knowledge and attitudes about opioid analgesic regulations David E. Weissman, MD; David E. Joranson, MSSW; and Margaret B. Hopwood, MA, RN, Milwaukee and Madison Wisconsin Medical Journal 1991 200 Wisconsin physicians were polled 54% of the respondents indicated that, due to concern of regulatory scrutiny, they will do one of the following: reduce drug dose or quantity, reduce the number of refills, or choose a drug in a lower schedule
8.
9. ADVERSE EFFECTS of OPIOIDS:GENERAL Constipation, nausea, narcotic bowel syndrome Sweating Sleep apnea, COPD, reduced resp. drive Rebound head aches Fatigue, confusion Cognitive impairment Endocrine & Reproductive effects (suppression of testosterone, menstrual irregularities) Lowered pain threshold (long term hyperalgesia due to altered pain receptors) Neurotoxicity (Demerol)
10. ADVERSE EFFECTS: OVERDOSE Decreased LOC RR < 12/min Bradycardia Speech slow & drawling “Nodding off” appear to fall asleep momentarily during conversation Patients may appear to be relatively alert when surrounded by others in a stimulating environment, only to drift into coma and die when going for a nap Pinpoint pupils Ataxia and falling Emotional lability Disinhibition Profuse sweating
12. ADDICTION Addiction occurs when a patient finds a drug effect so reinforcing that he has difficulty controlling its use Characterized by the four C’s: Loss off over use Control Use despite knowledge of harmful Consequences Compulsion to use the drug Craving
13. ADDICTION & OPIOIDS 50% chronic pain patients are addicted to opioids More formal studies found addiction rates to be 3 – 19% 54% of injection users inject morphine and hydromorphone, 42% inject heroin 7-31% prevalence for opioid misuse behaviors (running out, double doctoring)
14. CLINICAL FEATURES of ADDICTION Use of higher doses than needed for pain control Run out early Reluctant to try alternatives to drug of choice Acquire opioids from friends or other doctors Tendency to binge on opioids Deterioration in functional status Daily cycle of intoxication and withdrawal Experimenting with opioids (routes of administration)
15. OPIOID OVERDOSE:RISK FACTORS Dose, potency, underlying tolerance Age (extremes), renal insufficiency, respiratory disease Restarting opioids When a patient has been off of an opioid for 3 days or longer, restarting at the same dose may produce an overdose due to rapid decline in tolerance. Restarting the medication should be at 50% of the previous dose with gradual titration up.
22. PREPARE A TREATMENT PLAN Collect information and formulate a diagnosis Define and priorize treatment targets Devise a COMPREHENSIVE treatment plan Lifestyle changes Social changes Consider Psychological/Psychiatric intervention Integrate paramedical care providers Pharmacotherapy Interventional medical therapy
23. START WITH NON-OPIOIDS Opioids should only be initiated after an adequate trial of non-opioid analgesics and other modalities have failed Treatment success is measured by 25 – 50 % diminished pain, improved mood, and improved function Abstinence of pain is an unrealistic goal General reluctance to use opioids for headaches (opioids 2nd/3rd line at best)
24. INITIATING OPIOIDS Obtain informed consent (adverse effects, risk of dependence) Set expectations (25 – 50 % relief of pain) Identify one prescribing physician Sign a Treatment Agreement Evidence supports improved compliance Sandoval et al., 2005
26. COMPONENTS OF THE TREATMENT AGREEMENT Patient will not receive opiates from other sources Detail the amount of medication, and usage schedule Will not refill if the patient runs out early Will not replace if meds or script lost Patient will attend to regular visits Urine drug screen will be provided on request Physician can cease opiate script if agreement broken A copy of the agreement should be sent to other physicians involved in care Consequences of breaking the agreement should be specified and adhered to
27. DOCUMENTATION Keep an opiate flow sheet (record the amount dispensed and reasons for changes) Keep copies of scripts on chart Orange paper scripts are hard to photocopy See patient frequently on initiation of treatment At each visit, document: compliance, adverse effects, changes in mood and functional status, and analgesic effectiveness (VAS)
28. OPIATE SELECTION, DOSAGE & TITRATION There is no evidence that one opiate is superior to another, recommendations are based on specific patient populations Codeine is usually the initial choice because it is the least potent Be cautious of the acetaminophen component 4 g/d if healthy, 3.2 g/d if elderly, 2g/d if EtOH
29. OPIOID SELECTION 10% of Caucasians can’t convert codeine Fentanyl patch, oxicodone, & hydromorphone are less likely to cause sedation in elderly Active metabolites of morphine can accumulate in renal dysfunction Avoid oxycodone & hydromorphone in patients with addiction history Methadone is first choice in chronic pain among addicts Parenteralopioids should not be use in long-term pain due to risk of overdose, addiction, and other problems
30. Titration Start low and go slow! Opiates have a graded analgesic response with greatest benefit at lower doses and plateau at higher dosages Confirm that with each dosage increase there is a decline in the VAS pain score Avoid withdrawal especially in pregnancy Titrate slowly in the elderly, co-sedating med users, renal, resp, hepatic disease
31. BREAKTHROUGH PAIN Opioids should be taken on a regular basis Should be 1/3 of total scheduled dose or less Same opiate should be used for scheduled and breakthrough use No convincing evidence for combining different types of opioids
32. SWITCHING OPIOIDS Switch if lack of effectiveness or intolerable side effects Initial dose of new opioid should be 50% of the original opioid used Discontinue if pain remains unresponsive after 3 or 4 different opioids
33. SAFE PRESCRIBING Avoid prescriptions for large amounts Caution with high dependence opiates in those at risk Use rescue doses sparingly Should be time dependent rather than pain contingent Max of 4 – 6 doses per month Reduce next days dose by equal amount Tamper proof the prescription Keep track of the medications Running out early is common in addiction
40. IN SUMMARY Formulate a comprehensive treatment plan Include the patient & family in the decision making Consider opioids late in treatment of pain & use sparingly Monitor use of opioids closely Dispense small quantities of medication on any one visit Frequently evaluate effectiveness of treatment models & guidelines