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Migraine: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
If nonopioid medications do not provide adequate pain relief, we use codeine in combination with simple analgesics and sometimes butalbital or caffeine in the USA. We also use, in restrictive circumstances, more potent narcotic analgesics, such as propoxyphene, butorphanol, meperidine (pethidine), morphine, hydromorphone, and oxycodone, alone and in combination with simple analgesics.6,7 Because medication overuse and rebound headache pose a threat with narcotic use, these agents are most appropriate for patients whose severe headaches are relatively infrequent. Although butorphanol is a mixed agonist–antagonist, it clearly causes rebound headache and medication overuse syndromes. Transnasal butorphanol tartrate (1 mg followed by 1 mg 1 hour later) is an effective acute outpatient treatment that not only rapidly relieves the pain of migraine, but circumvents problems with oral absorption. Opioids should not be used more than 2 days a week on average (Table 6.17). In women with intractable menstrual migraine, we sometimes use narcotics on a more regular basis. These drugs are also especially helpful to patients who either do not respond to simple analgesics or cannot take ergots or sumatriptan. Pregnant women can use codeine or meperidine (pethidine) with caution.98 Opioids are also useful for patients who awaken in the middle of the night with a headache. Sedation, which is sometimes an undesirable side-effect, may help the patient go back to sleep and awaken headache-free in the morning.
Controlled Substances and Risk Management
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Hans Hansen, Art Jordan, Jennifer Bolen
Schedule III, IV, and V medications may be no less habituating than Schedule II drugs, and street value remains high for most controlled substances. In fact, hydrocodone is among the most widely misused and illegally distributed medications in America (Federation of State Medical Boards [FSMB], 1998). Other highly habituating medications that are erroneously and commonly considered benign in many treatment arenas include benzodiazepines, particularly alprazolam (Xanax®), and muscle relaxants, such as carisoprodol (Soma®), to name two. Many other examples exist, and regional variations may be important. Caution should be exercised when prescribing these medications. Even Schedule IV drugs, such as butorphanol tartrate (Stadol®), may be highly sought after by the patient. Misuse and drug-seeking behavior should be documented in the medical record and acknowledged by the prescriber. The prescriber’s decision to continue treatment in the face of misuse or abuse behavior is documented in the record as soon as this behavior becomes evident. If the prescriber chooses to continue prescribing controlled substances, the reason(s) must be clearly expressed, and a discussion of what safeguards and restrictions will be placed upon the prescriber–patient relationship is clearly documented. Initial encounters are recommended to document family or patient abuse/use history, including alcohol. Merely filling out a prescription each month without documenting functional indices, quality of life indices, pain scale, restorative sleep, and appropriateness to treatment should be avoided, and in state and federal cases this lack of documentation has been used as evidence of improper and/or illegal activity by prescribers.
Prolonged distribution of aerosolized PEGylated liposomes in the lungs of mice with bleomycin-induced pulmonary fibrosis
Published in Drug Development and Industrial Pharmacy, 2020
Kohei Togami, Yuki Maruta, Mao Nanbu, Hitoshi Tada, Sumio Chono
NBD-labeled liposomes were intrapulmonarily administered to mice with bleomycin-induced pulmonary fibrosis at an NBD-DPPE dose of 2.5 µmol/kg using a Liquid MicroSprayer after pentobarbital anesthesia. At each designated time point (0.25, 0.5, 1, 2, 4, and 8 h), mice were anesthetized via intraperitoneal injections of sodium pentobarbital and butorphanol tartrate at doses of 50 and 5 mg/kg, respectively, and bronchoalveolar lavage fluid (BALF) and AMs were collected as described previously [11,15]. To collect BALF and AMs, the trachea of each animal was immediately cannulated, and the lungs were lavaged three times with 0.75 mL of ice-cold PBS. The collected lavaged sample was immediately centrifuged at 700 × g for 5 min at 4 °C, and the supernatant (BALF) and precipitate (AMs) were separated. The AMs were extracted using 500 µL of 2 M NaOH. The NBD-DPPE concentrations in samples were measured using a microplate reader (Powerscan HT; DS Pharma Biomedical, Osaka, Japan) at an excitation and emission wavelengths of 485 and 528 nm, respectively. All experiments were performed on four mice per each time point for each group.
Deuterium oxide protects against myocardial injury induced by ischemia and reperfusion in rats
Published in Scandinavian Cardiovascular Journal, 2019
Yuko Ishikawa, Hirotoshi Kitagawa, Tadashi Sawada, Tomoyoshi Seto, Kan Takahashi, Toji Yamazaki
The present study was conducted in accordance with the guidelines of the National Institutes of Health, “Guide for the Care and Use of Laboratory Animals” (Publication No. 85-23, Revised 2011). We have obtained necessary approvals for all animal procedures from the institutional Animal Care and Use Committee of Shiga University of Medical Science (2015-3-10). Male Sprague-Dawley rats at 14–16 weeks of age, weighing 370–470 g, were used. Pentobarbital sodium (30–40 mg i.p.) was used to anesthetize the rats. Based on previous experience [10], pentobarbital sodium (15–20 mg/h) and butorphanol tartrate (0.025 mg/kg/h) were continuously infused intravenously into the right jugular vein, to achieve the required level of anesthesia. Heparin sodium (5 IU/kg/h) was administered to prevent coagulation. The rats were subjected to tracheotomy and ventilated with oxygen-mixed room air. The respiration rate was 70–80 min−1, and the tidal volume was 2.5 mL. Esophageal temperature was monitored as the body temperature. Maintenance of body temperature was accomplished using a lamp and heating pad. Mean arterial pressure (MAP), heart rate (HR), and continuous electrocardiogram (ECG) were monitored with a 3-lead ECG using PowerLab and LabChart (ADInstruments, Colorado, USA).
The expression of thymic stromal lymphopoietin in patients and animal models with eosinophilic otitis media
Published in Acta Oto-Laryngologica, 2018
Tomoya Miura, Atsushi Matsubara, Naomi Kudo, Ryutaro Hara, Junko Takahata, Akira Sasaki
The animal model of EOM was constructed using Hartley guinea pigs (weighing 250–350 g) as previously reported [7]. Animals were intraperitoneally injected with 2000 μg of ovalbumin (OVA) and 100 mg of aluminum hydroxide (alum) on day 0, and with 100 μg of OVA and 100 mg of alum on days 7 and 14, for general sensitization. From day 21, they were topically boosted by daily application of OVA solution; 100 μg of OVA by nasal drip, and 0.1 ml of OVA (1000 μg/ml) by intratympanic injection into both ears. The daily application of OVA was continued for 7 days (OVA 7-day group; n = 5) or 14 days (OVA 14-day group; n = 7). Animals not receiving any sensitization were used as the control group (n = 6). All procedures were carried out under anesthesia with a mixture of medetomidine hydrochrol, midazolam, and butorphanol tartrate (0.23 mg, 3.0 mg, and 3.75 mg/kg, respectively). Twenty-four hours after the final OVA injection, the animals were deeply anesthetized with sodium pentobarbital (50 mg/kg i.p.). The temporal bones on one side were then removed and fixed with 10% formaldehyde, and decalcified with EDTA 2Na in 0.1 M TRIS (pH 7.2). Thereafter, paraffin-embedded sections (3 μm) were prepared for immunostaining. The temporal bones on the other side were cut off around the tympanic ostium of the eustachian tube and immediately put into RNAlater for real-time PCR.