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Fetal and neonatal medicine
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
4.14. A 1 kg baby whose mother was given pethidine just before delivery is presented to you in the delivery room for resuscitation. He is cyanosed. His heart rate is 40/min and he is limp and apnoeic. Which of the following is/are appropriate? Intravenous atropine.Intracardiac adrenaline.Intravenous bolus of molar sodium bicarbonate.Intravenous nalorphine should be the first procedure.External cardiac massage.
Historical Notes
Published in Albert A. Kurland, S. Joseph Mulé, Psychiatric Aspects of Opiate Dependence, 2019
Albert A. Kurland, S. Joseph Mulé
The clinical experiences with the narcotic antagonists directed attention towards the possibility of utilizing a narcotic antagonist as a blockading agent in the management of the abstinent narcotic addict. However, it was apparent that neither nalorphine or its more potent analogue, levallorphan, were suitable for this purpose because of its method of administration, namely, parenterally. Furthermore, they were relatively short-acting, and since they were not pure antagonists, having both agonistic as well as antagonistic properties, there resulted a narrow range between their therapeutic effectiveness and toxicity. Dysphoric effects could be readily induced, as well as a dependency reaction giving rise to mild abstinence symptoms when the compounds were withdrawn.
An evaluation of difelikefalin as a treatment option for moderate-to-severe pruritus in end stage renal disease
Published in Expert Opinion on Pharmacotherapy, 2021
Zoe M. Lipman, Gil Yosipovitch
Prior to our understanding of the opioid system’s role in pruritus, activation of peripheral KORs has been widely shown to reduce transmission of pain. Nalbuphine, the first known KOR agonist/MOR antagonist, has shown success in treating both pain and itch (including uremic pruritus); however, its mu-antagonism and action in the CNS can lead to negative side effects like depression and restlessness [27]. The first kappa-selective KOR agonist was ketocyclazocine (the namesake of the kappa opioid receptor), a benzomorphan [28]. Early studies of benzomorphans like ketocyclazocine and ethylketazocine, nalorphine, Mr2023, and pentazocine revealed analgesic effects in both mice and dogs against both chemical and pressure stimuli, but also revealed unwanted side effects like sedation and ataxia. These side effects were assumed to be due to the drugs’ residual effects on other opioid receptors like mu- and delta- [29]. Arylacetamide enadoline (Cl-977) was also a potent antinociceptive agent that displayed a similar binding affinity for KORs as the benzomorphan ethylketocyclazocine but with increased KOR selectivity, and in turn, produced less MOR-related sedative side effects [30]. However, despite its analgesic potential, later studies showed that it induced potent diuresis as well as dose-limiting neuropsychiatric effects [31].
Pharmacotherapy for opioid addiction in community corrections
Published in International Review of Psychiatry, 2018
Robert P. Schwartz, Mary M. Mitchell, Kevin E. O’Grady, Sharon M. Kelly, Jan Gryczynski, Shannon Gwin Mitchell, Michael S. Gordon, Jerome H. Jaffe
Civil commitment laws (i.e. the use of the legal system to compel people to attend treatment) were passed in California in 1961 and subsequently in New York in 1962 (Anglin, 1988). The California programme’s stated goals were to treat, rehabilitate, and control but not to punish—although individuals who were non-compliant could be returned to additional institutional care for various violations (Kramer, Bass, & Berecochea, 1968). In California, the programme could last up to 7 years. Treatment had two phases including a residential phase for 6 months in prison (which in subsequent years was shortened) followed by a parole phase during which the patient had to meet with a parole agent, attend group counselling, undergo urine drug testing, and/or a challenge with nalorphine to uncover illicit opioid use. Only about one third of outpatients on parole who were committed to California’s programme were in good standing after 12 months (Kramer et al., 1968). Once methadone maintenance became available in California in 1970, patients in the California programme were permitted to participate (Anglin, 1988). The civil commitment programme in New York was considered less successful than the California programme (Inciardi, 1988b). It was operated by the New York State Department of Social Welfare, which had little experience with this population, in contrast to the Department of Corrections in California (Inciardi, 1988b).
Employing telehealth strategies for opioid addiction during COVID-19: implications for social work health care
Published in Social Work in Health Care, 2021
In the twentieth century, German researchers produced methadone, which was structurally different from morphine. Methadone, while still an addictive substance, yielded a different withdrawal reaction with less severe symptoms that allowed for its use in methadone assisted treatment of opioid use disorder (Dixon et al., 2016; Eibl et al., 2017). A significant milestone had been reached in the 1940s, with the discovery of nalorphine – an opioid agonist-antagonist which could reverse the suppressed breathing function caused by the overuse of morphine. Further research led to the development of a purer antagonist compound – naloxone, presently used by EMT and police to revive those experiencing overdose from heroin and opioid-based pain medications (Bernard et al., 2018).