Thesis (M. Med. Sc.)--University of Hong Kong, 1991.

Thesis (M.Med.Sc.)--University of Hong Kong, 1991. / Also available in print.

The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on July 13, 2010). Thesis advisor: Amy DeClue. "May 2010" Includes bibliographical references.

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T19:40:10Z : No. of bitstreams: 1 horta_ml_dr_botfm.pdf: 310795 bytes, checksum: f93f33ec3d563d0324729fb29f529e81 (MD5) / Vários antieméticos têm sido utilizados contra o prurido provocado pela morfina, utilizada por via peridural ou por via subaracnóidea. As diferenças de perfil farmacodinâmico entre as diversas drogas do grupo das benzamidas substituídas motivaram o estudo da alizaprida, embora a metoclopramida já se houvesse mostrado inativa com relação a esse aspecto. Em estudo duplo-cego, foram estudadas 84 mulheres submetidas a cesariana sob anestesia subaracnóidea (100 mg de lidocaína pesada a 5% e 0,2 mg de morfina), distribuídas aleatoriamente em dois grupos de 42 pacientes. Logo após o nascimento da criança, eram injetados, por via intravenosa, 50 mg de alizaprida (Grupo Alizaprida), ou 10 mg de metoclopramida (Grupo Controle). No período pós-operatório, as pacientes foram avaliadas com relação ao prurido (ausente, leve, moderado ou intenso) ou a outros efeitos adversos. Para as comparações entre porcentagens, foi utilizado o teste do Qui-quadrado, com a correção de Yates no caso de tabelas 2 x 2. Para as comparações entre porcentagens, foi utilizado o teste do Qui-quadrado, com a correção de Yates no caso de tabelas 2 x 2. Para as comparações entre médias, foi utilizada a análise de variância. Os valores foram considerados significativos quando P < 0,05. A alizaprida, usada na dose de 50 mg por via intravenosa, produziu uma redução na intensidade do prurido (P < 0,05), sem alteração da incidência de outros possíveis efeitos colaterais avaliados (hipotensão, sonolência, etc.) / Several antiemetic drugs have been shown to be effective against epidural or spinal morphine-induced pruritus. The pharmacodynamic differences among the drugs in the substituted benzamide group motivated the study of alizapride, though metoclopramide has already been shown not to alter this side effect. In a double-blind study, 84 womem submitted to cesarean under spinal anesthesia (100 mg of 5% hyperbaric lydocaine plus 0,2 mg of morphine) were randomly divided into two groups of 42 patients. Just after birth, they were injected intravenously either 50 mg of alizapride (Alizapride group) or 10 mg of metoclopramide (Control group). In the postoperativge period, they were assessed as for pruritus (absent, mild, moderate or severe) or any other side-effects. Percentages were compared using the chi-square test, with Yates correction in the case of 2 x 2 tables. Means were compared using the analysis of variance. Values were considered as significant when p < .05. Alizapride, in the conditions it was used, reduced severity of pruritus (p < .05) without altering the incidence of any other assessed side effects (hypotension, somnolence, etc.)

INTRODUCTION: Prolonged sedation treatment in neonatal pediatric populations is associated with opioid and benzodiazepine tolerance, dependence, and withdrawal syndrome. Despite the clinical relevance of this problem, we have limited knowledge of the long-term repercussions. Current literature focuses on premature neonates and suggests that opioid exposure may cause neurodevelopmental sequelae. The main objective of this literature review was to investigate what infant populations are at risk of developing short-term and/or long-term consequences from prolonged infantile sedation exposure. PUBLISHED STUDIES: A literature review was conducted on previous studies that focused primarily on the effects of opioids and benzodiazepines on infants and how it may affect the future development in these children. Studies show that short-term consequences include increased heart rate, increased respiratory rate, increased blood pressure, intracranial pressure fluctuations, and risk of further complications such as intraventriculat hemorrhage (IVH), periventricular leukomalacia (PVL), or even death. Long-term repercussions incluse the possibility of decreased brain volume, decreased head circumference and body weight, intelligence deficits, and social and behavioral issues. DISCUSSION: Standard pain and sedation management involves the use of opioids and benzodiazepines. Treatment duration and medication dosage depend on severity of the patient’s illness. Since prolonged sedation administration is often associated with tolerance and dependence, future research (such as long-term follow up of these infants at later neurological milestones) is necessary to determine possible short-term and long-term neurological and behavioural sequelae for infants exposed to prolonged treatment with opioids and benzodiazepines. Standardized pain and sedation management guidelines may also increase the effectiveness of treatment and drug administration.

Made available in DSpace on 2015-07-22T20:49:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-25 / Objetivos: Avaliar o hábito intestinal de pacientes com câncer que utilizam morfina. Analisar a efetividade de um programa terapêutico no controle da constipação secundária aos opioides. Método: Estudo de série de casos, prospectivo, não randomizado. Os pacientes admitidos no estudo eram portadores de câncer, idade superior a quatro anos, e utilizavam morfina para o controle de dor. Após 24 horas do início do uso da morfina, os pacientes receberam lactulose e, nos casos refratários, bisacodil. A avaliação do hábito intestinal foi realizada através de um questionário estruturado. Quando necessário, foi realizada a desimpactação das fezes por via anal ou oral. Resultados: Foram admitidos no estudo 22 pacientes, com idade entre cinco e 35 anos (média 16,7 anos). 27% (6/22) dos pacientes eram constipados antes da admissão no estudo. Na primeira semana do uso de morfina e lactulose, 40% (9/22) dos pacientes ficaram constipados. Na segunda e terceira semanas, a constipação ocorreu em 38,8% (7/18) e 16% (2/12), respectivamente. Com o protocolo terapêutico adotado foi possível controlar o quadro de constipação em 57% (11/22) dos casos. Conclusões: A constipação intestinal foi frequente nos pacientes que utilizaram morfina, 40%, 38,8% e 16%, respectivamente, na primeira, segunda e terceira semana, apesar do tratamento profilático com laxantes. Entretanto, o protocolo com atenção específica à constipação intestinal pode aumentar a adesão dos pacientes aos laxantes e minimizar as complicações da constipação, como a formação do fecaloma. São necessários estudos controlados com maior número de casos para o desenvolvimento de estratégias terapêuticas eficazes, multiprofissionais, que reduzam o sofrimento dos pacientes com câncer que necessitem utilizar a morfina. / Objective: Evaluate bowel habit in cancer patients using morphine. Analyze the effectiveness of a therapeutic program in controlling constipation secondary to opioid. Method: case study series, non-randomized, prospective. Patients admitted in the study were bearers of cancer, aged over four years, and using morphine for pain control. After 24 hours from the beginning of the use of morphine, patients were given lactulose and in refractory cases, bisacodyl. Evaluation of bowel habit was achieved through a structured questionnaire. When necessary, fecal desimpaction was performed by via anal or oral. Results: 22 patients were admitted to the study, aged between five and 15 years (average 16.7 years). 27% (6/22) patients had constipation before admission in the study. In the first week of use of morphine and lactulose, 40% (9/22) patients had constipation. In the second and third weeks, constipation occurred in 38.8% (7/18) and 16% (2/12), respectively. The therapeutic protocol adopted was able to control the constipation in 57% (11/22) of cases. Conclusions: constipation has been frequent in patients who have used morphine, 40%, 38.8% and 16% respectively in the first, second and third weeks despite the prophylactic treatment with laxatives. However, the protocol with specific attention to constipation can increase adherence to laxatives and minimize the complications of constipation, such as the appearing of fecaloma. Controlled studies are needed with largest number of cases for the development of effective therapeutic strategies, such multi-professional approach, which reduce the suffering of cancer patients who need to use morphine. / TEDE / BV UNIFESP: Teses e dissertações

Class of 2011 Abstract / OBJECTIVES: To compare fixed equianalgesic doses of morphine and fentanyl with regard to analgesic response for patients who presented to the ED with moderate to severe pain. METHODS: A retrospective cohort study of clinical data obtained through patient medical record review. Median pain reduction on the numeric pain scale was compared between the morphine and fentanyl groups. Independent variables of interest included: Age, sex, weight, initial pain score, injury severity, triage severity and injury type. RESULTS: : Pain scores were reported to be worse in the fentanyl group, p= 0.0002. However pain reduction was similar between the groups; median (IQR) of 2 (1-3) and 2 (1-4) in the morphine and fentanyl groups respectively, p= 0.6707. Injuries were more severe in the fentanyl group; injury severity score (ISS) median (IQR) of 5 (1-9) and 9 (3-12), p=0.0312 and more patients in the fentanyl group required additional opioids within 30 min of their first ED opioid dose, 15 (18%) and 31 (37%), p=0.006. CONCLUSION: Patients in both the morphine and fentanyl groups received similar analgesic response. Patients in the fentanyl group had a higher severity of injury, received higher doses of opioids from the EMS, and required the second dose of opioid sooner than patients in the morphine group.

No description available.

A simple method for IV self-administration of drugs by mice is described. When morphine (0.5 mg/kg) was made contingent on a nosepoke response, naive mice increased their rate of nosepoking when compared either with animals receiving contingent saline vehicle injectionsor yoked control animals receiving noncontingent morphine.

Previously, we demonstrated that exposure to morphine during gestation increases hypothalamic norepinephrine (NE) content and turnover rate in adult male rats and decreases these measures in adult females. To investigate the basis of these alterations, the present study examined the effects of prenatal exposure to morphine on tyrosine hydroxylase immunoreactivity (TH-IR) in the brains of adult male and female progeny. In male rats, prenatal morphine exposure significantly increased the density of TH-IR in cells and fibers in the caudal paraventricular nucleus of the hypothalamus (PVN) and locus coeruleus (LC), but had no effects in the lateral hypothalamus (LH). In female rats that were ovariectomized (OVX), prenatal morphine exposure significantly decreased the density of TH-IR in cells and fibers in the LC. Interestingly, an injection of estrogen in OVX control females reduced the mean optical density of TH-IR in the LC, but it was ineffective in drug-exposed females in the same brain region. Estrogen injections also reduced the mean optical density of TH-IR in the LH but not in the PVN of females, regardless of prenatal drug exposure. Thus, the present study suggests that prenatal morphine exposure induces long-term, sex-specific alterations in TH-IR in the PVN and LC of adult progeny.