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445 results
  • StatPearls: Prescription of Controlled Substances: Benefits and Risks [BOOK]
    StatPearls Publishing: Treasure Island (FL) Preuss Charles V. CV University of South Florida Kalava Arun A University of South Florida King Kevin C. KC Geisinger Wyoming Valley Medical Center BOOK
  • One of the single most difficult challenges for any prescriber is to distinguish between the legitimate prescription of controlled substances versus the prescription potentially used for illegitimate purposes. To discern the difference prescribers need to understand the signs, symptoms, and treatment of acute and chronic pain as well as the signs and symptoms of patients using controlled substanc…
  • Analysis of Drugs in Oral Fluid Using LC-MS/MS. [Journal Article]
    Methods Mol Biol 2019; 1872:237-259Coulter CA, Moore CM
  • Oral fluid analysis for drugs is increasingly used in a variety of testing areas: pain management and medication monitoring, parole and probation situations, driving under the influence of drugs (DUID), therapeutic drug monitoring, and testing for drugs in the workplace. The sample collection itself is straightforward, rapid, observable, and noninvasive, requiring no special facilities (compared …
  • Drugs and Lactation Database (LactMed): Carisoprodol [BOOK]
    National Library of Medicine (US): Bethesda (MD)BOOK
  • If carisoprodol is required by the mother, it is not necessarily a reason to discontinue breastfeeding. Slight sedation has occurred in a breastfed newborn infant who was exposed during pregnancy and lactation; sedation might be more pronounced in newborns who are exposed for the first time during nursing. Other agents may be preferred, especially while nursing a newborn or preterm infant, or whe…
  • Inhibition of In Vitro Metabolism of Opioids by Skeletal Muscle Relaxants. [Journal Article]
    Basic Clin Pharmacol Toxicol 2018; 123(3):327-334Moody DE, Fu Y, Fang WB
  • The purpose of this study was to test the hypothesis that skeletal muscle relaxants could inhibit the in vitro metabolism of common comedications opioids buprenorphine, methadone and oxycodone. The compounds [solubility-limited concentration (μM) studied] were as follows: baclofen (1000), carisoprodol (200), its metabolite meprobamate (1000), chlorzoxazone (200), cyclobenzaprine (1000), metaxalon…
  • Combination pharmacotherapy for the treatment of fibromyalgia in adults. [Review]
    Cochrane Database Syst Rev 2018; 2:CD010585Thorpe J, Shum B, … Gilron I
  • CONCLUSIONS: There are few, large, high-quality trials comparing combination pharmacotherapy with monotherapy for fibromyalgia, consequently limiting evidence to support or refute the use of combination pharmacotherapy for fibromyalgia.
  • Population health management in a small health system: Impact of controlled substance stewardship in a patient-centered medical home. [Journal Article]
    Am J Health Syst Pharm 2017; 74(18):1468-1475Homsted FAE, Magee CE, Nesin N
  • CONCLUSIONS: In 2013, Penobscot Community Health Care (PCHC), in Bangor, Maine, was fully engulfed in the prescription opioid crisis. At PCHC, patients' opioid doses were startlingly high. Within the organization, measures to ensure that prescriptions were being used as prescribed, and not diverted, were underutilized. PCHC responded to these challenges by developing a comprehensive approach to controlled substance stewardship, defined as a coordinated effort to promote the appropriate use of controlled substances, improve patient outcomes, reduce misuse and abuse, and decrease patient morbidity and mortality attributed to these high-risk medications. Since the establishment of the program, over 1,300 patient reviews have been conducted. During this time, the number of PCHC patients receiving chronic opioids has decreased by 67.2% and continues to drop, with a corresponding 65.6% decrease in the number of patients receiving benzodiazepines. Premature deaths were reviewed to identify associations with opioids prescribed at the time of death, which revealed a decline of 50% between 2013 and 2015. Since program inception, the reviews conducted based on internal quality-improvement reports have been expanded to include patients on combinations of opioids and benzodiazepines, high-dose opioids, and carisoprodol.Systematic approaches addressing areas of critical need in high-risk populations are integral to PHM efforts in small health systems. The pharmacy team can serve a unique role in identifying, developing, and implementing key PHM services. Coupled with strategic community partnerships, successful PHM integration can assist in the financial survival of small health systems.
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