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Search Results: 1 - 10 of 10982 matches for " Joseph Pergolizzi "
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The First Approved “Deuterated” Drug: A Short Review of the Concept  [PDF]
Robert B. Raffa, Joseph V. Pergolizzi, Robert Taylor
Pharmacology & Pharmacy (PP) , 2018, DOI: 10.4236/pp.2018.910033
Abstract:
The first deuterated drug has recently been approved by the U.S. FDA (Food & Drug Administration). A deuterated drug is a drug in which the hydrogen atom in one or more of the carbon-hydrogen bonds in its chemical structure is replaced by deuterium (heavy hydrogen, a hydrogen isotope that has a neutron, i.e., one neutron instead of the usual no neutrons). A carbon-deuterium (C-D) bond is more stable in the body than a carbon-hydrogen (C-H) bond. If the deuterium is strategically located in a drug’s chemical structure, the extra stability of the bond will be more resistant to metabolic breakdown, and the duration of drug action will be prolonged. We review the general concept of deuterated drugs, historical examples of the classes of application, and the new approval.
Hormone Replacement Therapy for Restoring the HPG Axis in Pain Patients Treated with Long-Term Opioid Analgesics  [PDF]
Srinivas Nalamachu, Joseph V. Pergolizzi Jr., Robert Taylor Jr., Jo Ann Le Quang, Joseph V. Pergolizzi III, Robert B. Raffa
Pharmacology & Pharmacy (PP) , 2018, DOI: 10.4236/pp.2018.911036
Abstract:
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.
Vitamin D and Number of Falls in a Long-Term Care Facility  [PDF]
Robert B. Raffa, Frank Breve, Robert Taylor Jr., Joseph V. Pergolizzi Jr.
Pharmacology & Pharmacy (PP) , 2012, DOI: 10.4236/pp.2012.34061
Abstract: Falls represent a significant contribution to the morbidity and mortality of the elderly population. Because vitamin D is important in bone physiology, the use of vitamin D to restore deficient bone and ameliorate the effects of bone fractures due to falls has become a common practice in recent years. Following introduction of widespread use, reports began to emerge that vitamin D not only aided in repair of fall-induced bone fractures, but that it also reduced the occurrence of falls. Vitamin D now has become a routine intervention as a fall-prevention measure. Early analyses found evidence of prevention efficacy (reduced falls), but recent analyses are more equivocal. We retrospectively examined the records of 350 patients in a long-term care facility in which vitamin D administration and the number of falls were recorded as part of a comprehensive database of care. We found a dramatic rise in vitamin D use over the period covered (2006 – 2011) and a corresponding dramatic decrease in the number of falls. However, the number of falls continued to decline after 2008, despite a plateau in number of patients on vitamin D, particularly females. It appears that other factors contribute to the overall decline.
Prophylaxis of Postoperative Nausea and Vomiting in Adolescent Patients: A Review with Emphasis on Combination of Fixed-Dose Ondansetron and Transdermal Scopolamine
Joseph V. Pergolizzi,Robert Raffa,Robert Taylor
Journal of Drug Delivery , 2011, DOI: 10.1155/2011/426813
Abstract: Postoperative nausea and vomiting (PONV) is a relatively common occurrence (20–30%) that delays discharge and, if persistent, can lead to serious complications. The incidence of PONV is a function of patient characteristics, the type and duration of surgery, the type of anesthesia, and the choice of pre-, intra-, and postoperative pharmacotherapy. There are no completely effective antiemetic agents for this condition, but recommendations for treatment strategies are separately available for pediatric and adult patients. Left unclear is whether adolescents should be guided by the pediatric or the adult recommendations. We review the developmental physiology of the relevant physiological factors (absorption, distribution, metabolism, and elimination). We also review the clinical evidence regarding the safety and efficacy of a fixed-dose combination of ondansetron (4 mg, i.v.) and transdermal scopolamine (1.5 mg).
Anesthesiologists' practice patterns for treatment of postoperative nausea and vomiting in the ambulatory Post Anesthesia Care Unit
Alex Macario, Louis Claybon, Joseph V Pergolizzi
BMC Anesthesiology , 2006, DOI: 10.1186/1471-2253-6-6
Abstract: A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed.The questionnaire was completed by 106 anesthesiologists (38% response rate), who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62% – 79%) of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55% – 74%) of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an IV fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%–7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18% – 36%) of practitioners would re-dose the 5-HT3-antagonist for PONV treatment.5-HT3-antagonists are the most common choice for treatment of established PONV for outpatients when no prophylaxis is used, and also following prophylactic regimens that include a 5HT3 antagonist, regardless of the number of prophylactic antiemetics given. Whereas 3% – 7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% of practitioners would re-dose the 5-HT3-antagonist for PONV treatment.When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV) [1,2]. Anesthesiologists agree that PONV is an important issue for patients [3]. Since PONV is important to patients, improving the quality of anesthesia care includes reducing the incidence and severity of PONV. A large number of prospective randomized clinica
The Role of Medical Literature, Clinical Trials and Experimental Research in Drug Product-Injury Litigation: A Primer with Two Examples  [PDF]
Jan M. Kitzen, Joseph V. Pergolizzi Jr., Robert Taylor Jr., Robert B. Raffa
Pharmacology & Pharmacy (PP) , 2018, DOI: 10.4236/pp.2018.96016
Abstract: When any type of product has been ordered to be removed from the marketplace by a governmental regulatory body, that action is a powerful indicator that the product has been determined to be unsafe for further use, thereby branding the product as defective and opening up the possibility of product liability litigation. When the product is a drug or medical device, it is especially serious since the possibility of personal injury (acute and/or chronic) or death may occur. Needless to say, in these situations, product injury litigation will almost surely follow. We review the definition and requisite claims needed to establish drug product liability, and the role that the medical literature, clinical trial data, and even experimental research data can play in product (drug)-injury litigation. We show how each of these resources played a significant role in two well-known cases: Fen-Phen and thimerosal. The ultimate goal of such knowledge is to make better informed decisions about drug safety.
“New-Look” Opioids: Biased Ligands  [PDF]
Joseph V. Pergolizzi, Michael H. Ossipov, Robert Taylor, Robert B. Raffa
Pharmacology & Pharmacy (PP) , 2018, DOI: 10.4236/pp.2018.97018
Abstract: Between the illicit use of opioids and attendant overdoses, and accidental overdoses with prescribed drugs, overuse of opioids has become a serious problem. At the same time, finding that fine balance between minimizing the risk of opioid misuse and abuse while at the same time providing access to treatment for patients who need pain control presents an ongoing challenge. Efforts to discover and develop better agents have led to what we term new-look opioids. We summarize here one such approach—known as biased ligands. By targeting a subset of GPCR signal transduction, this approach attempts to increase the separation between therapeutic and adverse effects.
Persistence of Healthcare-Associated (Nosocomial) Infections Due to Inadequate Hand Hygiene: Part 1—Biological and Treatment Factors  [PDF]
Robert B. Raffa, Joseph V. Pergolizzi, Robert Taylor, Sanjib Choudhuri, Robert Rodenbeck
Pharmacology & Pharmacy (PP) , 2018, DOI: 10.4236/pp.2018.98023
Abstract: The most frequent adverse event in the healthcare delivery system is acquisition of an infection within a healthcare facility. Since infection control measures are known, simple, and low-cost, we examine why the problem of healthcare-associated infections persists. Hundreds of millions of patients each year are affected by a healthcare-associated infection, with negative medical outcome and financial cost. It is a major public health problem even in countries with advanced healthcare systems. This is a bit perplexing, given that hygienic practices have been known and actively promoted. The objective is to address the question: doesn’t the use of disinfection, sterilization, handwashing, and alcohol rubs prevent the spread of pathogenic organisms? We conclude that the persistent high prevalence of nosocomial infections despite known hygienic practices is attributable to two categories of factors: biological and inherent shortcomings of some practices (considered in Part 1), and human factors (considered in Part 2). A new approach is presented in Part 3.
Persistence of Healthcare-Associated (Nosocomial) Infections Due to Inadequate Hand Hygiene: Part 2—Human Factors  [PDF]
Robert B. Raffa, Joseph V. Pergolizzi, Robert Taylor, Sanjib Choudhuri, Robert Rodenbeck
Pharmacology & Pharmacy (PP) , 2018, DOI: 10.4236/pp.2018.98024
Abstract: A healthcare-associated infection (defined as an infection acquired within a healthcare facility), such as due to transmission via medical equipment or by healthcare providers is the most frequent adverse event in the healthcare delivery system. But why does the problem persist, when infection control measures are known, simple, and low-cost? We reviewed some biological- and treatment-factors in Part 1, and we now review some human-factors. Healthcare-associated infections are a major public health problem even in advanced healthcare systems. They affect hundreds of millions of patients each year, and are responsible for increased morbidity, mortality, and financial burden. This is perplexing, since good-hygiene practices are known and promoted. Disinfection, sterilization, handwashing, and alcohol rubs should be more effective, but human-factors interfere. The persistent high prevalence of nosocomial infections, despite known hygienic practices, is attributable to two categories of factors: biological and inherent shortcomings of some practices (considered in Part 1), and human factors (considered here). A new approach is considered in Part 3.
Persistence of Healthcare-Associated (Nosocomial) Infections Due to Inadequate Hand Hygiene: Part 3—Application of Human Factors Engineering to an Ozone Hand Sanitizer  [PDF]
Robert B. Raffa, Joseph V. Pergolizzi, Robert Taylor, Sanjib Choudhuri, Robert Rodenbeck
Pharmacology & Pharmacy (PP) , 2018, DOI: 10.4236/pp.2018.98025
Abstract: Compliance to hand-hygiene guidelines in healthcare facilities remains disappointingly low for a variety of human-factors (HF) reasons. A device HF-engineered for convenient and effective use even under high-workload conditions could contribute to better compliance, and consequently to reduction in healthcare-acquired infections. We present an overview of the efficacy of a passive hand-spray device that uses solubilized ozonea strong, safe, non-irritant biocide having broad-spectrum antimicrobial propertieson glass surface, pigskin, and synthetic human skin matrix.
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