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The Place of Community Rescue Naloxone in a Public Health Crisis of Opioid Overdose

Pharmacology & Pharmacy 2019年第2期10卷 61-81页

作者： Joseph V. Pergolizzi Jo Ann lequang Robert Taylor Robert B. Raffa NEMA Research Naples FL USA Neumentum Palo Alto CA USA leq medical Angleton TX USA University of Arizona College of Pharmacy Tucson AZ USA Temple University School of Pharmacy Philadelphia PA USA

The recent large increase in deaths involving opioids (whether prescription or illicit, pure or adulterated, alone or in combination with other drugs) is the manifestation of a complex, and multifaceted problem consisting of psychological, psychosocial, medical, legal, regulatory, economic, cultural, and political components, among others. Because the problem involves issues related to both supply and demand, the solution is not obvious, simple, or quick. There is no easy fix. Preventing and treating opioid misuse and abuse requires a comprehensive, time-intensive, and expensive intervention supported by public policy and support through coordinated medical, regulatory, legal, and financial guidelines and practice. But until the long-term problems can be fixed, the immediate crisis of overdose deaths can be ameliorated by making available an opioid receptor antagonist to reverse the respiratory depression that is the cause of death to those who are in the best position to administer it in time (professionals, untrained bystanders, and even fellow drug abusers). The statistics overwhelmingly demonstrate that this is a life-saving medical intervention. Yet, there is still uncertainty about this intervention, and even some opposition to it. We describe the scientific basis for the approach and the issues surrounding its use to treat accidental or intentional overdose by pain patients, recreational opioid users, and addicts. We also describe the calls to limit the number of times it should be available to a user and the limitations of its effectiveness—mainly that it only addresses the acute death crisis, not the underlying problems that led to it.

关键词： Opioid Crisis Opioid Abuse Opioid Antagonist Community Naloxone

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Treating Insomnia in Older Adult Patients: Limiting Benzodiazepine Use

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Pharmacology & Pharmacy 2019年第3期10卷 116-129页

作者： Joseph V. Pergolizzi Jr. Robert Taylor Jr. Jo Ann lequang Errol Gould Robert B. Raffa NEMA Research Inc. Naples FL USA Neumentum Palo Alto CA USA leq medical Angleton TX USA Pernix Therapeutics Morristown NJ USA University of Arizona College of Pharmacy Tucson AZ USA Temple University School of Pharmacy Philadelphia PA USA

As aging comes, an increased prevalence of medical maladies and chronic pain independently or interactively disrupt sleep, which in turn can exacerbate either one. Furthermore, anxiety about pain can further negatively impact sleep. Fortunately, good quality sleep can improve pain management. Because benzodiazepine receptor agonists (including the “Z” drugs) can reduce anxiety and improve sleep, they seem a convenient choice. However, their use in this population, particularly for more than short-term (guidelines range from 2 to 6 weeks max), is not recommended because of increased likelihood of falls, further disruption of sleep, dependence, and problems with discontinuation (withdrawal). Besides, this population is often likely to take concomitant medication for pain or other central nervous system depressants leading to potentially serious and even life-threatening interactions involving synergistic amplification of respiratory depression (opioids being a particularly dangerous interaction). Therefore, insomnia in older adults should ideally be treated with a non-benzodiazepine receptor agonist;if indicated, they may be used, but should be closely monitored and tapered to avoid long-term adverse problems (direct or from withdrawal). Older adult patients with insomnia may be more optimally treated with sleep aids that do not interact with the GABAA receptor.

关键词： Pain Insomnia Older Adults Benzodiazepines “Z”-Drugs GABAA Receptor

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Hormone Replacement Therapy for Restoring the HPG Axis in Pain Patients Treated with Long-Term Opioid Analgesics

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Pharmacology & Pharmacy 2018年第11期9卷 473-480页

作者： Srinivas Nalamachu Joseph V. Pergolizzi Jr. Robert Taylor Jr. Jo Ann Le Quang Joseph V. Pergolizzi III Robert B. Raffa International Clinical Research Institute and Pain Management Institute Overland Park KS USA NEMA Research Inc. Naples FL USA leq medical Angleton TX USA College of Pharmacy University of Arizona Tucson AZ USA School of Pharmacy Temple University Philadelphia PA USA

Opioids are a treatment option for a variety of chronic pain conditions. But long-term opioid use can be associated with side effects, including hypogonadism. Opioid-induced hypogonadism (OIhG) is associated with the alteration of the hypothalamic-pituitary-gonadal axis (HPG). In males, hypogonadism can result in erectile dysfunction, reduced libido, fatigue, worsening mood, and increased risk of osteoporosis;in females, it can result in changes in the menstrual cycle and reduced libido, among other effects. A current treatment option for these patients is hormone replacement therapy. In this report, we discuss the problem of opioid-induced hypogonadism, and the therapeutic approach and the potential complications of treating pain patients using hormone replacement therapy.

关键词： Opioid Therapy Chronic Pain HPG Axis Hormone Replacement Therapy

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Assessment Methods Used during Clinical Years of Undergraduate medical Education at Moi University School of Medicine, Kenya

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Health 2022年第3期14卷 296-305页

作者： Japheth Kipkulei Simon Kangethe Frankline Boibanda Hellen Jepngetich Teresa Lotodo Joel Kirinyet Department of Pathology Thematic Section of Haematology and Blood Transfusion School of Medicine Moi University Eldoret Kenya Department of Community Health Family Medicine and Medical Education School of Medicine Moi University Eldoret Kenya Department of Environmental Health School of Public Health Moi University Eldoret Kenya Department of medical Laboratory Sciences School of Medicine Moi University Eldoret Kenya

Background: Assessment is the systematic collection, review, and use of information about educational programs undertaken to improve teaching and learning. It ensures quality in training programmes, motivates, and directs students’ learning. Assessment is also used for verification of achievement of objectives of training, feedback to students, licencing, certification, and screening of students for advanced training. It is guided by several principles, including the aims of the assessment (why assess), who to assess, timing (when to assess), what to assess, methods (how to assess), and the criteria for determining the usefulness of the assessment. Objective: To describe the assessment methods used during clinical years of the undergraduate programme at Moi University School of Medicine (MUSOM) and determine the student’s perspectives concerning the comprehensiveness, relevance, objectivity of various assessment methods and challenges faced. Methodology: The study was carried out at MUSOM and a cross-sectional study design was employed. Ten study participants were studied using convenience sampling. Data were collected using an interview guide and was analyzed using content analysis. An informed consent was obtained from the study participants. Results: The methods used during clinical years at MUSOM for assessing knowledge and its applications include multiple-choice questions (MCQ), short answer questions (SAQ), modified essay questions (MEQ), long essay questions (leq), and oral exam. Whereas the methods for assessing clinical competence include long case, short cases, objective structured clinical examinations (OSCE), and logbook. Students felt that MCQs were comprehensive, objective, and relevant to the curriculum content. They reported that feedback was not provided after assessments. Conclusion: The assessment methods used at MUSOM during clinical years include MCQ, SAQ, MEQ, leq, Short cases, long cases, and OSCE. Students reported varied perceptions of the

关键词： medical Education Assessment Methods Clinical Years Undergraduate

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