RESUMEN
Background: As the United States faces a national opioid crisis, opioid overdose deaths have significantly risen over the past decade. Patients with opioid use disorder, particularly those who use high-potency synthetic opioids, are at an increased risk of fatal opioid overdose. Alternative dosing strategies for the treatment of opioid use disorder must be considered in high-risk patients to prevent opioid overdose. Case: One patient with opioid use disorder at high risk for overdose was treated with extended-release (XR) intramuscular (IM) naltrexone initially every 28 days, but was frequently reporting increased cravings during the week prior to the next injection being due. This patient's dose of XR IM naltrexone was then given at an increased dosing frequency of every 21-24 days for three months. Opioid craving suppression was achieved without clinical or laboratory evidence of side effects or hepatotoxicity. Discussion: In patients with especially high risk of opioid overdose, consideration of novel dosing strategies for continuation of opioid abstinence is necessary. This is the first report demonstrating the short-term safety and efficacy of more frequent dosing of XR IM naltrexone. This case demonstrates that in select high-risk patients, more frequent dosing of XR IM naltrexone may be an effective strategy to reduce opioid cravings. Informed Consent: The case was reviewed with the Intuition's Privacy Officer who informed the authors that informed consent could not be obtained by the patient's family members due to 38 U.S.C 7332 restrictions on protected information. This manuscript was de-identified and approved by the institution's local privacy officer for publication in accordance with institution policy.
Asunto(s)
Naltrexona , Trastornos Relacionados con Opioides , Preparaciones de Acción Retardada/uso terapéutico , Humanos , Inyecciones Intramusculares , Naltrexona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Estados UnidosRESUMEN
Inhaler administration for patients with chronic obstructive pulmonary disease (COPD) can be challenging, as it requires correct recall and execution of multiple steps. Older adults may have a higher risk of incorrectly administering inhalers versus the general population due to age-related visual, cognitive, and functional impairments. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report states that in addition to advanced age, use of multiple inhalers and lack of previous inhaler education can negatively impact technique. Improper inhaler use can lead to poor disease control, increased acute care utilization, and reduced quality of life. Therefore, regular evaluation of technique is emphasized by the GOLD guidelines to improve patient outcomes. Health care professionals on geriatric interdisciplinary teams can work together to achieve proper technique and evaluate for age-related limitations that may guide the choice of inhalers in older adults with COPD. [Journal of Gerontological Nursing, 44(10), 10-15.].
Asunto(s)
Nebulizadores y Vaporizadores , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Administración por Inhalación , Factores de Edad , Anciano , Anciano de 80 o más Años , Cognición , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Desempeño PsicomotorRESUMEN
[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].