Doctors and Substance Misuse Disorder
Clare Gerada, Zaid Al-Najjar in Beneath the White Coat, 2020
In 2017 an anaesthetist was jailed after stealing codeine. He had opiate addiction. The trial judge accepted his problems were genuine, but stated as a doctor, he should have known where to get help. 1 For a host of reasons, many of which have been discussed in this book, doctors with mental illness, and especially those with addiction, do not know where to get help. They have poor access to confidential, accessible and supportive care. Doctors are often in denial, terrified of acknowledging to themselves, let alone to others, that they have a problem. Colleagues tend not see the obvious and ignore the unmistakable and unpleasant stale smell of alcohol, the pinpoint pupils of someone using opiates or the bizarre behaviour of colleagues using stimulants.
Palliative care
Peter Hoskin in Clinical Oncology, 2020
Medical care of a cancer patient does not stop when there is no curative treatment to offer and indeed over 50% of cancer treatments are palliative. In this area lie many of the greatest challenges in patient care – controlling pain, dyspnoea, vomiting, haemorrhage and other tumour-related symptoms. This chapter discusses these challenges in patient care. Careful evaluation of pain is important in this group of patients in order that treatment can be directed to the principal underlying cause. The measurement of pain on an objective scale is of value, particularly in monitoring response to treatment. The use of analgesics in this situation should be based on a simple three-step analgesic ladder progressively escalating the potency of drug used. Alongside specific management of cough and dyspnoea, for example aspiration of effusion and antibiotics for overt infection, cough sedatives based on codeine linctus could be tried.
Miscellaneous Methods of Analysis
Joseph Chamberlain in The Analysis of Drugs in Biological Fluids, 2018
The numbers of analyses of drugs in biological fluids carried out in laboratories throughout the world run into millions per year. This chapter briefly describes less popular methods of analysis with an indication of their applicability. Microbiological methods of drug assay are among the few bioassays for drugs where the biological effect rather than chemical or physicochemical properties of the drug was used to measure its concentration in unknown samples. In the serial dilution method of analysis, the sample is incubated in a liquid nutrient containing viable microorganisms. The hippuric acid can be readily extracted from the incubation system and the enzyme activity determined according to conventional methods. Flow injection analysis is an analytical technique has attracted much theoretical and practical development, particularly in pharmaceutical analysis where there is a demand for the monitoring of materials and where the demands of sensitivity and specificity are not great, such as analysis of caffeine, corticosteroids, and codeine in tablets.
Dihydrocodeine: safety concerns
Published in Expert Review of Clinical Pharmacology, 2016
Wojciech Leppert, Jarosław Woroń
Dihydrocodeine (DHC) is a semi-synthetic analogue of codeine, which was formed by the hydrogenation of the double tie in the main chain of the codeine molecule - instead of a double bond between carbons 7 and 8 DHC possesses a single bond. DHC is used as an analgesic and antitussive agent and for the management of dyspnea and opioid addiction. Limited data is available on the potency of DHC to other opioids. The analgesic effect of DHC is similar to codeine and approximately twice as potent as tramadol for an oral route. In contrast to codeine and tramadol, DHC analgesia seem to be irrespective of CYP2D6 activity due to parent compound analgesic effects, multiple metabolic pathways and limited role of dihydromorphine in DHC analgesia. As the drug is commonly available appropriate titration and dosing and knowledge of its metabolism and possible adverse effects are important for safe prescription of DHC.
Solubility of codeine phosphate in carbitol + 2-propanol mixture at different temperatures
Published in Drug Development and Industrial Pharmacy, 2020
Homa Rezaei, Abolghasem Jouyban, Fleming Martinez, Mohammad Barzegar-Jalali, Elaheh Rahimpour
The solubility profile of codeine phosphate in the carbitol and 2-propanol mixtures at 293.2–313.2 K are determined and correlated with some developed cosolvency models. Moreover, the density values of codeine phosphate saturated solutions are also determined and fitted with the Jouyban–Acree model. The model accuracy is investigated by calculating the mean relative deviations (MRDs%). The thermodynamic parameters of codeine phosphate dissolution in the non-aqueous mixtures of carbitol and 2-propanol are also computed by using van’t Hoff and Gibbs equations.
To Prescribe Codeine or Not to Prescribe Codeine?
Published in Journal of Pain & Palliative Care Pharmacotherapy, 2014
Marc L. Fleming, Matthew A. Wanat
A recently published study in Pediatrics by Kaiser et al. (2014; Epub April 21, DOI: 10.1542/peds.2013-3171) reported that on average, over the past decade, children aged 3 to 17 were prescribed approximately 700,000 prescriptions for codeine-containing products each year in association with emergency department (ED) visits. Although, guidelines from the American Academy of Pediatrics issued warnings in 1997 and reaffirmed their concerns regarding the safety and effectiveness of codeine in 2006, it is still often prescribed for pain and cough associated with upper respiratory infection. With the impending rescheduling of hydrocodone combination products to Schedule II, physicians and mid-level prescribers may be compelled to prescribe codeine-containing products (e.g., with acetaminophen) due to reduced administrative burden and limits on Schedule II prescriptive authority for nurse practitioners and physician assistants in some states. This commentary expounds on the safety and effectiveness concerns of codeine, with a primary focus on patients in the ED setting.
Related Knowledge Centers
- Morphine
- Antitussive
- Morphine Derivatives
- Opiate
- Analgesic
- Antidiarrheal
- Antihypertensive