FENTANYL A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Fentanyl: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84421-6 1. Fentanyl-Popular works. I. Title.
iii
Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.
iv
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on fentanyl. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
v
About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
vi
About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
vii
Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON FENTANYL................................................................................................. 3 Overview........................................................................................................................................ 3 Federally Funded Research on Fentanyl ........................................................................................ 3 E-Journals: PubMed Central ....................................................................................................... 22 The National Library of Medicine: PubMed ................................................................................ 23 CHAPTER 2. NUTRITION AND FENTANYL ....................................................................................... 69 Overview...................................................................................................................................... 69 Finding Nutrition Studies on Fentanyl....................................................................................... 69 Federal Resources on Nutrition ................................................................................................... 73 Additional Web Resources ........................................................................................................... 73 CHAPTER 3. ALTERNATIVE MEDICINE AND FENTANYL................................................................. 75 Overview...................................................................................................................................... 75 National Center for Complementary and Alternative Medicine.................................................. 75 Additional Web Resources ........................................................................................................... 78 General References ....................................................................................................................... 79 CHAPTER 4. CLINICAL TRIALS AND FENTANYL ............................................................................. 81 Overview...................................................................................................................................... 81 Recent Trials on Fentanyl............................................................................................................ 81 Keeping Current on Clinical Trials ............................................................................................. 82 CHAPTER 5. PATENTS ON FENTANYL ............................................................................................. 85 Overview...................................................................................................................................... 85 Patents on Fentanyl ..................................................................................................................... 85 Patent Applications on Fentanyl ................................................................................................. 94 Keeping Current ........................................................................................................................ 106 CHAPTER 6. BOOKS ON FENTANYL ............................................................................................... 107 Overview.................................................................................................................................... 107 Book Summaries: Online Booksellers......................................................................................... 107 The National Library of Medicine Book Index ........................................................................... 107 Chapters on Fentanyl................................................................................................................. 108 CHAPTER 7. PERIODICALS AND NEWS ON FENTANYL ................................................................. 109 Overview.................................................................................................................................... 109 News Services and Press Releases.............................................................................................. 109 Newsletter Articles .................................................................................................................... 112 Academic Periodicals covering Fentanyl ................................................................................... 112 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................. 115 Overview.................................................................................................................................... 115 U.S. Pharmacopeia..................................................................................................................... 115 Commercial Databases ............................................................................................................... 116 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 119 Overview.................................................................................................................................... 119 NIH Guidelines.......................................................................................................................... 119 NIH Databases........................................................................................................................... 121 Other Commercial Databases..................................................................................................... 123 APPENDIX B. PATIENT RESOURCES ............................................................................................... 125 Overview.................................................................................................................................... 125 Patient Guideline Sources.......................................................................................................... 125 Finding Associations.................................................................................................................. 127 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 129 Overview.................................................................................................................................... 129 Preparation................................................................................................................................. 129
viii Contents
Finding a Local Medical Library................................................................................................ 129 Medical Libraries in the U.S. and Canada ................................................................................. 129 ONLINE GLOSSARIES................................................................................................................ 135 Online Dictionary Directories ................................................................................................... 135 FENTANYL DICTIONARY ......................................................................................................... 137 INDEX .............................................................................................................................................. 193
1
FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with fentanyl is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about fentanyl, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to fentanyl, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on fentanyl. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to fentanyl, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on fentanyl. The Editors
1
From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
3
CHAPTER 1. STUDIES ON FENTANYL Overview In this chapter, we will show you how to locate peer-reviewed references and studies on fentanyl.
Federally Funded Research on Fentanyl The U.S. Government supports a variety of research studies relating to fentanyl. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to fentanyl. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore fentanyl. The following is typical of the type of information found when searching the CRISP database for fentanyl: •
Project Title: AGMATINERGIC CONTROL OF OPIOID TOLERANCE AND DRUG ABUSE Principal Investigator & Institution: Fairbanks, Carolyn A.; Cell Biology and Neuroanatomy; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 30-APR-2004
2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
4
Fentanyl
Summary: (provided by applicant) This proposal is for an Exploratory/Developmental Grant Application (R21), specifically addressing RFA # PAR-01-047, the Cuffing Edge Basic Research Award (CEBRA) program. Recently, agmatine (decarboxylated arginine) has been isolated from mammalian brain & spinal cord and found to antagonize NMDA receptors and inhibit nitric oxide synthase (NOS). Because glutamate is thought to drive synaptic plasticity by activating both NMDA receptors and NOS in series, agmatine may participate in control of synaptic plasticity and related behavioral phenomena (e.g. learning, memory, chronic pain, opioid tolerance and self-administration) as a neuromodulator of glutamate. Exogenously administered agmatine is neuroprotective in models of cerebral ischemia (Gilad, 1996) and spinal cord injury (Yu et. al., 2000) and prevents development of opioid analgesic tolerance (Kolesnikov 1996; Fairbanks, 1997), all considered to be processes requiring plasticity. In addition to these published reports, preliminary data presented here demonstrates that exogenous agmatine prevents fentanyl self-administration. The primary goal of the proposed study is to determine whether endogenous agmatine modulates opioid-induced analgesic tolerance and self-administration. That objective will be addressed by determining the relationship of agmatine levels to opioid tolerance and self-administration. First, agmatine concentration will be systematically measured in brain and spinal cord regions thought to be involved in opioid addiction and analgesic tolerance. These measurements will be compared across multiple strains of mouse known to have differential sensitivities to induction of opioid analgesic tolerance and self-administration. If, as exogenous agmatine findings predict, endogenous agmatine protects against induction of opioid analgesic tolerance and self -administration, then mouse strains with relatively low concentrations of central nervous system agmatine will be more sensitive to induction than those with high concentrations of CNS agmatine, an inverse correlation. The second component of the project will determine whether manipulating levels of CNS agmatine changes analgesic tolerance and self-administration also through an inverse relationship. The results of these proposed Phase I CEBRA R21 studies will determine whether or not there exists a modulatory relationship between endogenous agmatine and the glutamatergic mechanisms underlying opioid tolerance and selfadministration. Such a finding would provide a rationale for pursuing in depth mechanistic clarification of the role of endogenous agmatine in opioid analgesic tolerance and self-administration, a strategy that would comprise the subsequent PHASE 11 CEBRA R01 application. Elucidation of a role for endogenous agmatine in modulation of the development of opioid tolerance and self-administration may lead to the development of a novel class of drugs or alternative methods to treat addiction, or to the identification of new therapeutic targets. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ANESTHESIA AND COCAINE INDUCED CNS EXCITOTOXICITY Principal Investigator & Institution: Whittington, Robert A.; Anesthesiology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: Cocaine is the most frequently reported illicit drug used by patients presenting to emergency rooms in the U.S. The clinical course of these patients is often complicated by trauma, the need for emergent surgical intervention, and drug toxicity. Thus, anesthesiologists have a critical and increasing role in the acute care of these patients. Cocaine intoxication produces recurrent seizure activity that is often resistant to standard anticonvulsant therapy and can ultimately lead to permanent neurological damage and even death. This central nervous system (CNS) excitotoxicity may be due to
Studies
5
the drug's inhibition of sodium conductance as well as to the inhibition of monoamine reuptake, resulting in increased extracellular amino acid and monoaminergic neurotransmitter concentrations in specific CNS pathways. Moreover, it has been well established that the susceptibility to this CNS excitotoxicity is often amplified with chronic use of the drug. The basis for this increased susceptibility may be related to alterations in extracellular CNS monoaminergic and amino acid neurotransmitter release following repeated exposure to the drug. There is a paucity of scientific information regarding the effect of anesthetic drugs on the CNS excitotoxicity of cocaine. Consequently, microdialysis and electroencephalographic techniques will be employed in a chronically instrumented rat model, following acute and chronic cocaine exposure, in order to determine the effect of anesthetic drugs (fentanyl and dexmedetomidine) on: 1) cocaine-induced epileptiform activity and 2) extracellular dopaminergic and glutamatergic neurotransmitter concentrations in the nucleus accumbens (NAC) of the brain, an area linked to the behavioral and excitatory effects of cocaine. We hypothesize that anesthetic agents modify the CNS excitatory effects of cocaine by altering extracellular dopaminergic and glutamatergic neurotransmitter concentrations in the NAC. This information will provide a fundamental understanding of the interaction between commonly used anesthetic drugs and cocaine in terms of modification of central neurotransmitter concentrations and CNS excitotoxicity. This information is essential if we are to better understand the anesthetic management of cocaine-abusing patients and may also be relevant to the many patients taking psychiatric medications, drugs that also alter CNS dopaminergic and glutamatergic activity. This award will allow me to obtain the investigational skills and knowledge base that will enable me to develop into a clinician-scientist and independent investigator in anesthesiology and neuroscience research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BEHAVIORAL EFFECTS OF OPIOIDS IN VOLUNTEERS Principal Investigator & Institution: Zacny, James P.; Associate Professor; Anesthesia and Critical Care; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2002; Project Start 15-MAR-1995; Project End 29-FEB-2004 Summary: Until recently, little attention had been paid to characterizing behavioral effects of opioids in normal volunteers (i.e., volunteers with no history of drug or alcohol dependence) using the rigorous testing methodologies that had been employed in the studies with abusers. For the past three years, we have employed an abuse liability/behavioral toxicology testing methodology to examine the effects of a number of different opioids that are typically given to patients for postoperative pain. This application will have four series of studies that are logical continuations of studies from the previous grant period. In the first series of studies, we will focus on opioids that are typically given to patients who are recovering from outpatient surgery. These patients might be at home or at work, engaging in different activities that may or may not be adversely affected by the opioids. It is vitally important to understand the behavioral toxicology of these opioids, yet rigorous toxicology studies (employing multiple measures of behavior and examining a range of doses that might be used by patients) have not been conducted to date. Therefore, we plan to continue our opioid characterization studies in normal volunteers, focusing on four oral drugs commonly used in outpatient settings: hydrocodone, oxycodone, propoxyphene, and tramadol. In the second series of studies, we will follow up on a study from the previous granting period in which some of morphine's subjective effects were attenuated by a painful stimulus. In four studies, we will use a cumulative dosing procedure recently developed
6
Fentanyl
in our laboratory to examine the degree to which a painful stimulus modulates the subjective and psychomotor effects of morphine, meperidine, butorphanol and nalbuphine. We will study different opioids at different doses and at different levels of painful stimulation in order to better understand how pain, which frequently accompanies opioid administration in patients, modulates behavioral effects of opioids. In the third series of studies, we will again follow up on a previous study from our laboratory in which we demonstrated that a painful stimulus modulated the reinforcing effects of an opioid, fentanyl. We propose to utilize a patient controlled analgesia (PCA) methodology to examine the degree to which four different opioids- morphine, meperidine, nalbuphine and butorphanol- maintain self-administration, and the degree to which self-administration is modulated by a painful stimulus. In the fourth series of studies, the effects of psychomotor stimulants alone and in combination with an opioid will be examined. Psychomotor stimulants are often given as adjuncts to opioids in patients suffering from chronic malignant pain to offset the sedating and impairing effects of high-dose opioid therapy. We will study buprenorphine in combination with three psychomotor stimulants- d-amphetamine, methylphenidate, and pemoline- to determine the relative pharmacodynamic profiles and which combination(s) produces the most analgesia with the least degree of troublesome side effects (including marked sedation and psychomotor/cognitive impairment). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BEHAVIORAL PHARMACOLOGY OF OPIOID TOLERANCE Principal Investigator & Institution: Young, Alice M.; Professor; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: BIOAVAILIBILITY OF FENTANYL TRANSDERMAL SYSTEMS WHILE RECEIVING CHRONIC OPIOID TH Principal Investigator & Institution: Rosenthal, Jeffrey A.; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: CHARACTERIZATION OF TOXICITY WITH SPINAL OPIATES Principal Investigator & Institution: Yaksh, Tony L.; Professor; Anesthesiology; University of California San Diego 9500 Gilman Dr, Dept. 0934 La Jolla, Ca 920930934 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2006 Summary: (provided by applicant): Continuous intrathecal infusion of concentrated morphine is widely used in pain therapy. Surprisingly, until recently there has been no study of the safety of such infusions. We investigated the effects of 28-day intrathecal morphine infusion in a canine model. Unexpectedly, at high morphine concentrations (as used in humans), we noted an aseptic mass of inflammatory cells (granuloma) arising from the dura-arachnoid, not the parenchyma, proximal to the catheter tip. Granulomas were not seen with vehicle or a variety of non-opioid agents. The alpha2 adrenergic agonist clonidine suppressed the granuloma. These observations lead to four
Studies
7
hypotheses. 1. Granuloma induction by morphine is proportional to local concentration in cerebrospinal fluid and not simply total dose. 2: Effect is mediated by an opioid agonist action and is not limited to morphine. 3. The granuloma results from a local degranulation of dural mast cells leading to movement of inflammatory cells from the dural vessels. Accordingly, granuloma-inducing potency will be proportional to the ability to degranulate dural mast cells in ex vivo dural preparations. 4. Granulomainducing effects and dural mast cell activation are suppressed by local alpha2 receptor agonists and by a mast cell stabilizer. We will address these hypotheses using the canine model to examine the effects of continuous intrathecal infusion of equipotent doses of mu opioid agonists (morphine, morphine-6-glucuronide, L-methadone, hydromorphone, fentanyl or DAMGO) or equimolar concentrations of inactive opioid molecules (naloxone, morphine-3-glucronidc, D-methadone). In vivo treatment with a mast cell stabilizer, nedocromil sodium, will be examined for its effect on granuloma formation. In parallel studies, kinetics studies will permit comparisons based on measured CSF concentrations. Interaction between morphine and alpha2 agonists (clonidine, dexmedetomidine) will be studied by co-delivery. Granuloma formation and local mast cell degranulation and cytokines will be assessed histochemically and by CSF analysis. In summary, our initial work, provides the first definitive preclinieal data defining the effect, the attenuation by clonidine, and a novel mechanistic hypothesis for drug-induced degranulation of dural mast cells which suggests a novel method for the ex vivo screening of new agents. These studies are significant: 1) increasing incidence of reports of morphine-granulomas emphasize it is not rare; 2) our investigation of other opioids provide the first time assessment of the spinal safety of agents which are now in wide clinical use; and 3) this issue impacts on all agents targeted for intrathecal delivery. Accordingly, data obtained here regarding the role of local CSF concentration, the safety of non-morphine agents and the potential ameliorating effects of adjuvant agents all provide novel information to refine the utility of this important therapeutic regime. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CLUB-DRUGS AND HIV RISK BEHAVIOR IN HIGH-RISK MEN Principal Investigator & Institution: Colfax, Grant N.; San Francisco Dept of Public Health 101 Grove St, Room 308 San Francisco, Ca 94102 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 28-FEB-2008 Summary: (provided by applicant): My goal is to become a leader in HIV prevention intervention research. K23 award support will allow me to develop the skills I need to become an independent researcher, with a focus on developing and implementing behavioral interventions to prevent HIV. I will acquire training in 1) behavioral science to better understand HIV risk behavior and theories about substance use; 2) qualitative research skills to perform formative research for intervention development; and 3) designing and implementing HIV prevention interventions by answering formative research questions and translating formative research data into a full-scale intervention. I will apply this new knowledge to the study of club-drug using men who have sex with men (MSM). While effective behavioral interventions have been developed for MSM and injection drug user (IDU) populations, less attention has been paid to club-drug use among MSM, and the relationship between club-drug use and high-risk sexual behavior. I hypothesize that 1) club drugs directly contribute to high-risk sexual behavior among MSM; 2) characterizing the size, stability, and sociodemographics of club-drug and sexual networks of MSM is critical in designing interventions to reduce club-drug associated sexual risk behavior; and 3) a network intervention is a feasible and potentially effective way to reduce sexual risk behavior associated with club-drug use.
8
Fentanyl
To address the current gaps in club-drug and sexual risk behavior research, the 3 specific aims of my research plan during the K award period are 1) to identify, through quantitative work, which types and combinations of club drugs are associated with high-risk sexual behavior, and to characterize MSM club-drug networks and the sexual networks of club-drug using MSM; 2) to conduct qualitative interviews and collect field observation notes among club-drug using MSM to examine the interpersonal and contextual factors associated with club-drug networks and environments, not measurable through quantitative research; and 3) using results from specific aims 1 and 2, to design and pilot the feasibility and acceptability of a club- drug network intervention to reduce sexual risk behavior associated with club-drug use. Results from these complementary specific aims will be used to secure R01 funding for a larger, phase III randomized trial to determine the efficacy of a network-based club drug intervention to reduce high-risk HIV sexual behaviors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DETERMINANTS OF DRUG CHOICE Principal Investigator & Institution: Woolverton, William L.; Professor; Psychiatry and Human Behavior; University of Mississippi Medical Center 2500 N State St Jackson, Ms 39216 Timing: Fiscal Year 2002; Project Start 01-JUN-1999; Project End 31-MAY-2005 Summary: Since drugs are usually available to humans simultaneously with other reinforcers, an understanding of factors that control choice between drugs and other drug or non-drug reinforcers is important to a complete understanding drug abuse. Indeed, the behavioral transition to virtually exclusive choice of drug over other reinforcers could be considered the defining feature of drug abuse. The experiments described in the present proposal will utilize an animal model of drug abuse, i.v. selfadministration by monkeys, to examine behavioral and pharmacological variables that control drug choice. By understanding these variables, we hope to enhance our understanding of factors that determine the transition to uncontrolled drug use. The research should contribute important basic information to the development of novel approaches to the treatment of drug abuse. The research has three Specific Aims, each framed in the context of a model that generally predicts choice for reinforcers other than drugs. Specific Aim 1 is to investigate the interaction between reinforcer magnitude and frequency as determinants of drug choice. Results will be compared to predictions of the matching law, that organisms will apportion behavior according to relative magnitudes of reinforcement. Specific Aim 2 is to investigate delay of reinforcement as a controlling variable in drug choice. Results will be compared to predictions of the hyperbolic delay discounting model and models of "impulsivity" and "self-control." Since most drug abusers have a choice between drug and non-drug reinforcers, Specific Aim 3 is to investigate the nature of the alternative reinforcer to drug as a controlling variable in choice.Behavioral economics predicts that choice is controlled by the relative substitutability of alternative reinforcers that are available. The experiments in each Specific Aim will examine representatives of two classes of abused drugs, psychomotor stimulants (cocaine) and opioids (alfentanil). In addition, to examine the generality of our conclusions to behavior maintained by non-drug reinforcers, we will study behavior maintained by food. The proposed research will help elucidate the drug-organismenvironment interaction that determines drug abuse, and may provide a laboratory model of uncontrolled drug use. From the point of view of basic behavioral research, the research will expand our understanding of choice in general. Theories of choice should accommodate drug choice as well as choice involving non-drug reinforcers. Further, an
Studies
9
understanding of the variables that control the choice to self-administer a drug is crucial to the refinement of drug abuse treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DISCRIMINATIVE STIMULUS EFFECTS OF OPIOID WITHDRAWAL Principal Investigator & Institution: France, Charles P.; Professor; Pharmacology; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002; Project Start 01-MAY-1995; Project End 31-MAY-2003 Summary: Despite the availability of several, effective pharmacotherapies, opioid abuse continues to pose a major public health problem worldwide. Currently available pharmacotherapies are effective in only some patients and the need continues for new and better treatments for opioid abuse. Prior research under this grant developed discrimination procedures for studying opioid dependence and withdrawal. Studies in this application will use those, and other, procedures to examine the development of dependence to novel opioids and to test hypotheses regarding drug interactions and the possible attenuation of dependence and withdrawal. Specific Aim I will determine whether opioid or non-opioid tolerance or dependence develops during treatment with the novel fentanyl derivative mirfentanil. Specific Aim II will examine the role of P450 enzymes in the morphine-like effects of codeine and oxycodone and determine whether other drugs (N-methyl-D-aspartate antagonists [NMDA] and nitric oxide synthase [NOS] inhibitors) modify opioid tolerance and dependence. These studies will compare methadone and its stereo isomers because these opioids also have effects at NMDA receptors. Upon completion of a study on LAAM dependence and withdrawal, studies under Specific Aim III will test the hypothesis that variations among mu opioids in their effects on receptor internalization and G-protein coupling will be expressed as differences in tolerance and dependence. Naltrexone will be established as a discriminative stimulus in untreated monkeys (Specific Aim IV) to begin a characterization of behavioral effects that might be important to the therapeutic utility of these drugs (e.g., alcohol abuse). Specific Aim V will use pigeons to study efficacy and selectivity differences among opioids and also to determine whether hypothesized interactions between different opioid receptors has functional consequences for drug dependence and withdrawal. The procedures developed under this grant provide a unique set of conditions for evaluating the effects of other drugs on behaviors related to and predictive of the subjective effects of withdrawal in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: EFFECT OF NASAL FENTANYL ON POSTANESTHETIC BEHAVIOR IN CHILDREN Principal Investigator & Institution: Galinkin, Jeffrey; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: EFFECTS OF DEXTROMETHORPHAN, NALOXONE & FENTANYL ON EXPERIMENTAL PAIN Principal Investigator & Institution: Staud, Roland M.; Associate Professor; University of Florida Gainesville, Fl 32611
10
Fentanyl
Timing: Fiscal Year 2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HERB-OPIOID INTERACTIONS Principal Investigator & Institution: Shen, Danny D.; Member; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2002; Project Start 10-SEP-2001; Project End 31-MAY-2004 Summary: (provided by applicant):Extract of SJW; Hypericum perforatum, has gained widespread popularity as an over-the-counter, natural antidepressant. Until recently, SJW was thought to be well tolerated and relatively safe. Within the past year, adverse metabolic interactions have been reported between SJW and several narrow therapeutic index drugs, notably cyclosporine indinavir, and digoxin. The interactions are now recognized to involve induction of two drug disposition mechanisms: cytochrome P450 3A4 enzyme and the active efflux pump, P-glycoprotein, both leading to profound reductions in blood or plasma drug concentration that compromises the therapeutic efficacy of the affected drug. Natural and synthetic opioids are the first-line agents for the palliative treatment of severe pain that results from cancer and cancer treatment. It is well recognized that depression is a co-morbid condition of severe and poorly controlled cancer-related pain. Given the widespread recognition of St. Johns wort as a "mood enhancer" and natural antidepressant, cancer pain patients receiving opioid analgesics may well turn to this herbal preparation for relief of depressive symptoms. The overall objective of this research proposal is to investigate if significant interactions occur between two widely used opioid analgesics - oxycodone and fentanyl and St. John wort extract through laboratory-based studies in healthy volunteers. The studies will assess the potential clinical significance of the interactions with respect to opioid analgesia efficacy and side effects, and provide scientific insights into the pharmacokinetic mechanisms underlying any observed interactions. The oxycodone arm of the study is designed to 1) investigate the induction of CYP3A4-mediated Ndemethylation which is the major detoxification pathway for oxycodone, and 2) resolve the inductive effects of SJW on intestinal and hepatic CYP3A4 through intravenous and oral administrations of a CYP3A-specific, in vivo catalytic probe -midazolam. The fentanyl arm of the study will 1) assess the effects of SJW on the brain uptake and efflux kinetics of fentanyl through pharmacokinetic-pharmacodynamic (PK-PD) modeling of miotic response over time during and following intravenous infusion of the opioid, and 2) to evaluate the changes in analgesia and side effects of fentanyl upon pretreatment with SJW that may have resulted from induction of Pgp at the BBB. A third arm of the study will assess whether SJW has analgesic properties of its own, or is capable of promoting opioid analgesia. Overall, the proposed research will provide a definitive assessment of the potential and clinical significance of adverse interactions between SJW and opioids in the context of cancer pain therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: HEROIN & ITS METABOLITES PARTIALLY MIMIC EFFECTS OF COCAINE Principal Investigator & Institution: Rowlett, James K.; Assistant Professor; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2003
Studies
11
Summary: Despite the prevalence and detrimental consequences of combined cocaineheroin ("speedball") abuse, relatively little is known about the pharmacological mechanisms underlying this form of polydrug addiction Previous studies using drug discrimination techniques, a proposed model of the subjective effects of drugs, have shown that selective f opioid agonists (e g , fentanyl) can enhance the interoceptive effects of cocaine when administered in combination, yet do not consistently mimic the effects of cocaine when administered alone The present study examined the effects of heroin and its active metabolites 6-monoacetylmorphine (6-MAM) and morphine in squirrel monkeys trained to discriminate intramuscular injections of cocaine from saline Under test conditions, cocaine engendered dose-related increases in drug-lever responding, reaching nearly 100% accompanied by little change or an increase in the rate of responding Doses of heroin, 6-MAM and morphine also eng endered d oserelated increases in drug-lever responding, reaching a maximum of r 80% in most subjects and accompanied by pronounced decreases in response rate Pretreatment with the opioid antagonist naltrexone surmountably antagonized the cocaine-like effects of heroin, morphine and 6-MAM, resulting in dose-dependent shifts to the right in the opioid dose-response functions The results show that heroin, 6-MAM and morphine partially mimic the interoceptive effects of cocaine, but only at doses that suppress the rate of responding The partial cocaine-like effects of heroin, 6-MAM and morphine may be mediated via f opioid mechanisms as suggested by surmountable antagonism by naltrexone Collectively, these results suggest that at relatively high doses, cocaine and heroin share subjective effects that may, in turn, contribute to the abuse of speedball combinations in people PUBLICATIONS Rowlett, J K and Spealman, R D Opioid enhancement of the discriminative stimulus effects of cocaine Evidence for involvement of f and k opioid receptors Psychopharmacology 140 217-224, 1998 Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IATROGENIC OPIOID DEPENDENCE IN CRITICALLY ILL CHILDREN Principal Investigator & Institution: Lugo, Ralph A.; Pharmacy Practice; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-AUG-2004 Summary: (Applicant's Abstract) Critically ill children in the pediatric intensive care unit often require long-term sedation and analgesia. Fentanyl has a rapid onset, short duration of action, and stable hemodynamic profile. Thus, it is the most desirable opioid for continuous analgesia and sedation in the pediatric intensive care unit. However, continuous administration of fentanyl often leads to rapid development of tolerance, progressive dose escalations, and ultimately iatrogenic opioid dependence. Discontinuation of fentanyl in these children will precipitate acute abstinence syndrome which may compromise the care of the child. Currently, it is not fully understood which patients are at risk for opioid dependence and withdrawal, nor is there a validated method of objectively assessing the severity of withdrawal. Although the optimal treatment of iatrogenic opioid abstinence syndrome has not been established in critically ill children, oral methadone is often used to facilitate fentanyl discontinuation while preventing signs and symptoms of withdrawal. However, no data are available regarding the optimal dose or pharmacokinetics of methadone in this patient population. This proposal aims to generate data on wide ranging aspects of iatrogenic fentanyl dependence, including diagnosis and evaluation of its severity, determination of risk factors for its development, and the pharmacokinetics of fentanyl and methadone in critically ill children. The specific aims of these studies are: 1) to validate a
12
Fentanyl
clinical scoring tool to be used by the bedside nurse to objectively measure the severity of iatrogenic fentanyl abstinence syndrome. This scoring tool may be used to determine when treatment of fentanyl withdrawal is necessary; 2) to quantitate fentanyl exposure by measuring fentanyl's cumulative area under the concentration-time curve; 3) to evaluate the relationship between systemic fentanyl exposure and the risk of iatrogenic opioid abstinence syndrome; and 4) to define the pharmacokinetics and bioavailability of methadone which is used to treat fentanyl withdrawal in these critically ill children. These data will significantly augment our understanding of opioid withdrawal in critically ill children and increase our knowledge of fentanyl and methadone pharmacokinetics, both of which are critical in safely administering these agents to children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INDIVIDUAL PREDOCTORAL DENTAL SCIENTIST FELLOWSHIP Principal Investigator & Institution: Tseng, Raymond J.; Oral Biology; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2002; Project Start 01-APR-2002 Summary: Activation of neuroendocrine responses by stress has been shown to suppress anti-viral immune responses, including natural resistance mechanisms and adaptive immunity. For example, elevated plasma corticosterone (Cort) levels, arising from activation of the hypothalamic-pituitary-adrenal (HPA) axis, have been shown to suppress mononuclear cell trafficking and cell- mediated immunity. In addition, increased tissue and circulating catecholamines (CAT), due to activation of the sympathetic nervous system (SNS), suppress activation of virus-specific CD8+ T-cells. Recent studies have shown that stress can also suppress activation of natural killer (NK) cell function during an influenza viral infection, and that the mechanism of suppression is independent of Cort or CAT. In preliminary studies, the opioid receptor antagonist naltrexone has been shown to block stress-induced suppression of NK activity during an influenza A/PR8 viral infection, suggesting that opioids may play an important immunomodulatory role in the resistance to viral infection. As it has been shown that opioids can modulate NK cell function, and that stress can activate opioid responses, this project was designed to investigate the immunomodulatory role of endogenous opioids during an acute viral infection of the respiratory track. An animal model of influenza will be used to dissect the mechanism by which opioids modulate NK responses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: MEASURING AND MODIFYING ETHANOL'S REINFORCING EFFECTS Principal Investigator & Institution: Winger, Gail D.; Senior Research Scientist; Pharmacology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2007 Summary: (provided by applicant): In rhesus monkeys, the reinforcing effects of intravenously delivered ethanol lead to high ethanol intake, high ethanol blood levels, marked intoxication, and, under continuous access conditions, "binge" patterns of ethanol consumption, physiological dependence, and withdrawal signs. These are some of the characteristics of severe human alcoholism, a condition that is likely to result, at least in part, from this pharmacologically based reinforcing effect of ethanol. We suggest
Studies
13
that response-contingent delivery of i.v. ethanol is a fairly "pure" measure of these reinforcing effects of ethanol, relatively unmodified by the aspects of taste, fluid volume, and gastrointestinal absorption that appear to prevent consumption by monkeys of equally large amounts of ethanol by the oral route. We propose to use behavioral economic procedures (demand curves) to quantify these reinforcing effects of i.v. ethanol and to compare them with those of other intravenously delivered drugs. In further studies, these procedures will be used to determine how the combination of ethanol and other drugs of abuse changes the reinforcing effects of both drugs. Because demand functions are unaltered by changes in drug potency, but are modified by changes in drug effectiveness, the measurements should indicate whether the various drug combinations result in a greater reinforcing effectiveness than either drug alone, or whether the potencies of the drugs as reinforcers are enhanced when they are combined. Finally, this same analysis will be used to determine how the treatment drugs of naltrexone and acamprosate modify the reinforcing effects of intravenous ethanol, again either by decreasing its reinforcing effectiveness or by decreasing its potency as a reinforcer. These studies will provide information not currently available on how ethanol compares with other drugs in terms of its reinforcing effectiveness, information that could impact policy decisions regarding legalization or decriminalization of other drugs of abuse. Data relevant to the behavioral and pharmacological mechanisms underlying polydrug abuse involving ethanol, and underlying pharmacological treatment of alcoholism will also be obtained. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MECHANISM OF AN OPIOID, ORPHANIN FQ, ON COLONIC FUNCTION Principal Investigator & Institution: Epstein, Miles L.; Professor; Medicine; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 30-JUN-2004 Summary: (Adapted from the Applicant's Abstract): A novel, endogenous opioid-like peptide, orphanin FQ/nociceptin (OFQ/N), and its receptor, ORL-1, have been isolated from brain. OFQ/N and ORL-1 protein and mRNA are widely expressed in the central nervous system and periphery. OFQ/N has a complex pharmacology and has been shown to be either analgesic or hyperalgesic in rodent assays of cutaneous pain. The role of OFQ/N in visceral pain is unknown. Our preliminary studies show that OFQ/N, like morphine or other opioid compounds, significantly inhibits colonic transit in vivo and stimulates colonic smooth muscle in vitro. More important, OFQ/N's actions are insensitive to opioid receptor antagonists such as naloxone. Thus, OFQ/N and its receptor ORL-1 may be novel therapeutic targets for the treatment of visceral pain which would lack the abuse and addiction liabilities of opioids such as morphine or fentanyl. The overall objective of this proposal is to evaluate the role of OFQ/N in visceral pain and colonic motility. Our hypothesis is that OFQ/N is an endogenous principal modulator of these processes. Utilizing both human and murine species, we propose to test this hypothesis through the following specific aims: (1) operationally identify the location(s) within the organism where OFQ/N acts to regulate colonic activity and evaluate the interactions between OFQ/N and opioids in vivo; correlate the functional studies with structural studies which will localize the expression of OFQ/N and its receptor ORL-1 mRNA and polypeptide in murine and human colon; (2) because 5-HT has been implicated as an important neurotransmitter involved in the control of GI motility and visceral sensation, we will examine 5-HT's involvement in the mechanism of action of OFQ/N on colonic function in human and murine tissue, (3) we will pioneer
14
Fentanyl
the use of the mouse in an assay of visceral pain and use this assay to evaluate the role of OFQ/N in modulating visceral pain by utilizing ORL-1 receptor knockout animals in this novel visceral pain assay. The proposed studies will contribute new and clinically relevant data on a novel endogenous opioid which could lead to the development of analgesics with reduced GI side effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MECHANISMS OF DRUG DEPOSITION IN HAIR Principal Investigator & Institution: Ruth, James A.; Pharmaceutical Sciences; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 15-MAY-1997; Project End 30-APR-2004 Summary: (Adapted from the application): Workplace drug testing has now become fairly commonplace as a surveillance procedure in the American workplace. Hair testing has the potential to offer numerous advantages over urine and serum testing; some of those being 1) reduced cost; 2) convenience of sample storage and shipment; and 3) reduced psychological stress for the test subject. Despite these potential advantages, hair testing, however, has yet to become an accepted procedure due to unresolved issues as: 1) efficacy of drug extraction from hair; 2) differentiation between drugs contacted externally on the hair versus drugs ingested and deposited via the systemic circulation; 3) the effects of sweat and sebum on quantitation of hair drug levels; 4) correlation between ingested drug and distribution into hair; and 5) effects of pigment in hair deposition. The last issue may be the most important primarily because hair pigment in drug disposition has raised issues regarding differential sensitivity in and between various ethnic groups. In addition, gender bias may be significant when hair treatments such as dyes and salon treatments have the potential to remove or chemically alter or destroy deposited drugs. During the previous granting period, the investigators have accomplished the following objectives:(1) quantitation of hair growth rate via incorporating daily injections of rhodamine and measuring distance between fluorescent bands deposited in hair. Accessible water space was determined using a stage micrometer and equilibration of hairs with tritium oxide of known specific activity; (2) serum constituents as [C-14]urea, [Ca-45]calcium+2, [Cl-36]chloride- were quantitated and differences were noted in differentially pigmented hair; (3) highly covalently bound [S-35]cysteine was quantitated and a difference was noted in pigmented vs. lesspigmented hair. It was found that essentially no cysteine could be liberated on 24-hour extraction, consistent with possible covalent incorporation into hair matrix; (4) studies with fentanyl (as opposed to [H-3]-d-amphetamines and a benzoyl esterified amino alcohol, a model of cocaine) demonstrated that systemic delivery was not dose related, larger concentrations were extractable following external exposure, and "capping" of surface amino and hydroxyl groups resulted in significantly decreased, suggesting an interaction with hair chemical functionalities. Thus, a difference and a mechanism for fentanyl incorporation into hair via external and systemic route were semiquantitatively determined. Studies were also accomplished with labeled cocaine, nicotine, and flunitrazepam; and (5) sodium sulfide digestion resulted in significantly greater recovery of base-stable drugs than NaOH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies
•
15
Project Title: MODULATION OF EFFECTS OF MORPHINE BY ABUSED STIMULANTS Principal Investigator & Institution: Platt, Donna M.; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002 Summary: Morphine and other mu opioids mimic and/or modulate the subjective effects of cocaine, possibly reflecting mutual stimulation of mesolimbic dopamine activity Less is known about the capacity of cocaine and related stimulants to modulate the subjective effects of morphine The present study investigated the effects of cocaine, amphetamine and reference drugs, administered alone and combined with morphine, in squirrel monkeys trained to discriminate morphine from vehicle Additional studies determined the ability of opioid and dopamine receptor antagonists to attenuate the effects of morphine and the morphine-like effects of other drugs The effects of morphine were mimicked by the mu opioid agonist fentanyl, but not the delta opioid agonists SNC 80 and BW 373U86 or the kappa opioid agonist U50,488H, and were antagonized by the opioid antagonist naltrexone, but not the dopamine antagonist flupenthixol In a subgroup of monkeys, the effects of morphine also were mimicked b y cocaine, amphetamine and the dopamine transport inhibitor GBR 12909, but not the norepinephrine transport inhibitor talsupram or the serotonin transport inhibitor fluoxetine, and were antagonized by flupenthixol but not naltrexone In these subjects, pretreatment with cocaine or amphetamine enhanced the effects of morphine, whereas in other monkeys pretreatment with either stimulant attenuated morphine's subjective effects The results demonstrated individual differences in morphine-like effects of stimulants that are mirrored by individual differences in their interactions with morphine Furthermore, different mechanisms appear to mediate the subjective effects of morphine and the morphine-like subjective effects of cocaine and amphetamine Such differences could have implications for the management of speedball abuse among individuals who combine stimulants and opioids for ostensibly different reasons (i e , to enhance the subjective state of euphoria or to attenuate the undesi rable effects of the individual drugs) PUBLICATIONS Rowlett JK, Negus SS, Shippenberg TS, Mello NK, Walsh SL and Spealman RD Combined cocaine and opioid abuse From neurobiology to the clinic NIDA Res Mongr 178:55-57, 1998 Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: NEOPAIN MULTICENTER TRIAL: DATA COORDINATING CENTER Principal Investigator & Institution: Barton, Bruce A.; Senior Statistician and Vice President; Maryland Medical Research Institute, Inc 600 Wyndhurst Ave Baltimore, Md 21210 Timing: Fiscal Year 2001; Project Start 01-JUN-1999; Project End 31-MAY-2004 Summary: Frequent invasive procedures occur during neonatal intensive care causing pain and stress in preterm neonates during a critical period of increased brain plasticity. Repetitive painful experiences or prolonged exposure to analgesic drugs in preterm neonates may significantly alter their clinical and neurobehavioral outcomes. Analgesic practices recorded prospectively in 109 Neonatal Intensive Care Units (NICUs) showed that opioids and benzodiazepines were most commonly used, with large variations in clinical practice. No analgesia/sedation was given to 73.5 percent of neonates during NICU care or invasive procedures. A pilot randomized trial of morphine, midazolam, or placebo therapy in 69 preterm neonates showed reduced behavioral responses to pain and evidence of decreased incidence of death or neurologic injury in the morphine
16
Fentanyl
group. Trends for increased weight gain, earlier discharge, and other clinical outcomes support the need for and the feasibility of a definitive randomized trial. The NEOPAIN Multicenter Trial will randomize 940 ventilated neonates (24-32 weeks gestation) from 11 NICUs to receive continuous infusions of morphine or placebo. This design will provide 80 percent power for the detection of a 30 percent reduction in the composite outcome of neonatal death, Grade III or IV intraventricular hemorrhage, or periventricular leukomalacia. Data collection will include (maternal/infant) demographic, clinical and behavioral data. Other clinical outcomes include weight gain, severity of neonatal illness, and durations of NICU and hospital stay. Behavioral outcomes include neurobehavioral and psychometric testing at the time of hospital discharge. Trial coordination, data management and statistical analyses for the NOPAIN Trial are described in this application. The use of opioids (morphine and fentanyl) in preterm neonates is increasing without scientific evaluation and with scarce data on their clinical or adverse effects. The need for and clinical impact of prolonged analgesia in the NICU must be defined now before widespread use occurs. To provide data about the safety of opioid use, the effects of early pain/stress on the long-term neurobehavioral outcomes of prematurity in neonates without analgesia must be compared to the effects of analgesia use in neonates. This trial can provide those data. Thus, the results of this trial have the potential to significantly alter clinical practice in the NICU and reduce a major cause of severe morbidity and mortality in neonates. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: NEUROENDOCRINE ALTERATIONS IN FIBROMYALGIA AND IBS Principal Investigator & Institution: Chang, Lin; Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 13-SEP-1999; Project End 31-AUG-2004 Summary: The long-range goal of this proposal is to develop an understanding of the etiology of chronic functional pain syndromes, such as fibromyalgia (FM) and irritable bowel syndrome (IBS). The constellation of symptoms in the FM and IBS suggest a failure to appropriately activate pain modulatory mechanisms, a failure to activate neuroendocrine stress mechanisms, and an alteration in the autonomic response. Our general hypothesis is that a neurobiological model exists in patients with FM and IBS, which includes as its primary components alterations in the following CNS responses to stressors: inadequate antinociceptive response, blunted hypothalamic-pituitary-adrenal (HPA) axis response and altered autonomic balance and responsiveness. By applying similar methodologies across two functional pain syndromes (FM, IBS, and IBS plus FM), we will elucidate if altered CNS circuits are shared by these functional disorders or are site-specific and may explain the differences in symptom expression in the somatic or visceral domains. The first aim is compare the visceral and somatic pain thresholds before and after a noxious conditioning stimulus in three female patient populations (IBS, FM and IBS plus FM) with female controls, which would allow us to determine if altered perceptual responses are due to hypersensitive afferent pathways, or to a failure to activate antinociceptive systems. To further characterize alterations in the activation of specific antinociceptive pathways in response to conditioning stimuli, we will assess the effect of pharmacological manipulations of the opioid system (fentanyl, naloxone), and the noradrenergic system (corticotropin-releasing hormone (CRH), dexamethasone) on pain thresholds. Finally, we will compare brain activation in regions known to play central roles in antinociception in the 4 study populations with H215O PET brain imaging during visceral and somatic stimuli before and after the conditioning stimulus. In the second aim, we will test the responsiveness of the HPA axis, which has been
Studies
17
shown to be altered in patients with FM, in the 4 study populations and address the potential mechanisms to explain these HPA axis alterations. To characterize these alterations, we will obtain serial measurements of plasma cortisol and ACTH over a 24hour period to assess baseline alterations in the diurnal pulsatile rhythm and synchrony of ACTH and cortisol. We will also assess HPA axis responsiveness to acute stress by comparing ACTH and cortisol levels before and after a visceral or somatic conditioning stimulus. Finally, in our third aim, we will compare autonomic responses to visceral and somatic stimuli during visceral and somatic conditioning paradigms. In order to determine if the response of central autonomic networks to visceral or somatic stimulation differ between the study groups, regional brain activation will be correlated to autonomic responses during the visceral and somatic stimuli in the PET studies using covariate analysis. The combination of experimental approaches should improve our understanding of the CNS mechanisms underlying functional pain syndromes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OPIOID MODULATION OF IMMUNOCOMPETENCE Principal Investigator & Institution: Bidlack, Jean M.; Professor; Pharmacology and Physiology; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002; Project Start 01-AUG-1989; Project End 30-JUN-2004 Summary: (provided by applicant) This competitive renewal proposal is directed at determining which cells from the mouse immune system express 6, g and K opioid receptors, and whether activation of these cells alters the amount of receptor expressed and the distribution of the multiple opioid receptors among the different lymphocyte populations. By using fluorescent opioids and flow cytometry, we have developed a novel indirect fluorescent method for detecting about: opioid receptors. This method is more sensitive than radioreceptor binding methodology. Double-labeling experiments have shown the highest level of about receptor expression on mouse thymocytes and macrophages, and on human microglial cells. The studies proposed in this application focus on the detection of 6 and/.t opioid receptors. Based on functional studies, the first hypothesis to be tested is that mouse thymocytes and CD4+ and CD8+ T cells express;5 opioid receptors. To detect 6 receptors, two approaches will be compared. FITC-labeled derivatives of the 6-selective ligand, naltrindole, will be used in a manner similar to the labeling of the receptor with the FITC-conjugated K ligand. The second approach will use specific antibodies directed against the 6 receptor. The second hypothesis to be tested is that mouse peritoneal and T cells express the/,t opioid receptor. The g receptor will be labeled with either a FITC-labeled derivative of fentanyl or morphine, and/or antibodies directed against the la opioid receptor. Flow cytometry will be used to detect the labeled receptors. For both 6 and g receptors, the goal is to develop an optimal method for detecting the receptor, and then to use this method to study receptor expression. The third hypothesis is that activation of lymphocytes will increase the expression of opioid receptors since levels of receptor mRNA have been shown to increase with cell activation. Collectively, these studies will use an innovative approach and technique to determine which cells from the immune express about:, 6, and about opioid receptors and if receptor expression is altered with activation of the cells. These studies will lay the foundation for determining the cellular mechanisms by which opioids alter immune function and immunological responses to viral infection, including AIDS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
18
•
Fentanyl
Project Title: OPIOIDS IN CANCER PAIN & DRUG ABUSE--OPTIMIZING THERAPY Principal Investigator & Institution: Kharasch, Evan D.; Professor; Anesthesiology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-MAY-1999; Project End 31-MAR-2004 Summary: The overall long-term objective of this proposal is to develop a patientoriented research program in opioid pharmacology, specifically directed towards the therapy of cancer pain and of substance abuse. A principal component of this program will be the development of beginning clinical investigators. The specific research objectives are to 1) expand existing research which investigates mechanisms of variability in human opioid disposition, pharmacodynamics and clinical efficacy, and endeavors to optimize opioid therapy of cancer pain and of substance abuse, 2) facilitate program expansion into underutilized therapies such as nonsteroidal antiinflammatory drugs and emerging issues such as outpatient postoperative pain therapy, and 3) mentor beginning clinician-scientists in patient-oriented research, utilizing the above framework to spawn independent research programs. A critical focus will be interfacing in vitro and in vivo aspects of human drug disposition and efficacy, and translating recent explosive discoveries in basic enzymology and pharmacogenetics of drug disposition into clinical strategies for optimized therapy. Oral and parenteral opioids ar the primary therapy for opiate addiction and cancer pain. Methadone maintenance is the cornerstone of opiate abuse therapy, a vital and effective strategy for HIV/AIDS risk reduction, and is widely used for cancer pain treatment. l-alpha-acetylmethadol (LAAM) is the first new opioid in three decades approved for opiate abuse. Oral transmucosal fentanyl (OTFC) is the first drug ever specifically developed for treating breakthrough cancer pain. All these opioids are characterized by extreme, unexplained, and unpredictable interindividual variability in their pharmacokinetics, causing inadequate pain treatment, opioid abstinence syndrome, treatment failures, and frequent unwanted side effects. Unexplained age- and gender-dependent variabilities also prevail. These opioids are metabolized by cytochrome P450 in the intestine and liver. The mechanisms of individual and age-dependent variability in the metabolism of these opioids are, however, unknown. Indeed, little is known about the P450s responsible for human clinical metabolism of OTFC, LAAM and methadone (and its individual enantiomers, which have divergent efficacies), and the factors affecting these P450s. Consequences for clinical drug effect are similarly unknown. Experiments in vitro will use human liver and intestinal microsomes to identify relevant P450 isoforms and probe enantiomeric and drug-drug interactions, while complementary in vivo clinical investigations will verify these identifications and establish the influence of age, gender, and diet on opioid disposition and pharmacologic effects. Successful identification of the P450s and factors affecting metabolism, clearance, blood concentrations, and clinical effects of OTFC, LAAM and methadone will improve the clinical outcome and reduce the costs of opiate addiction and cancer pain treatment, and provide insights into age-, gender-, and environmentally-dependent changes in drug disposition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: PHARMACOKINETIC STUDY OF INTRATHECAL MORPHINE & FENTANYL IN HEALTHY V Principal Investigator & Institution: Hood, David D.; Wake Forest University 2240 Reynolda Rd Winston-Salem, Nc 27106 Timing: Fiscal Year 2002
Studies
19
Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PHARMACOLOGICAL PLASTICITY IN HUMANS Principal Investigator & Institution: Eisenach, James C.; Professor; Wake Forest University 2240 Reynolda Rd Winston-Salem, Nc 27106 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-JAN-2007 Summary: A major aim of this Center is to perform translational clinical research closely linked to advances in fundamental knowledge on pain pharmacology, generated in each of the laboratory Projects. As such, a major focus and goal of Project V is to provide continuous interaction between laboratory and clinical investigators and projects. This process is aimed at refining both the laboratory and clinical hypotheses and to generate novel, testable concepts. All clinical protocols within this Center are designed, implemented, analyzed, and communicated internally by Project V. This includes proper power analysis, use of innovative study designs, collection of additional experimental data to support new methodologies, support for regulatory agency application, both at the institutional and federal level, consistent application of psychophysical testing, and standardization of methods to allow efficient comparison of results across studies. Dr. Rauck will be primarily responsible for the studies in volunteers and postoperative patient, Dr. Tobin will be responsible for the PET studies, and Dr. Coghill for psychophysical testing across all studies. Project V will examine, in four clinical trials, hypotheses generated by Projects I-IV, as well as its own hypotheses in psychophysics from Dr. Coghill. Included in these trials will be critical testing of the applicability of new methodology (i.e., a novel, more efficient, and clinically relevant approach to the study of analgesic drug interactions); examination of the predictive value of results in experimental models of pain in normal volunteers to subacute and chronic clinical pain settings; and determination of the contribution of hypersensitivity to the overall pain experience in patients following surgery and those with neuropathic pain. Unique pharmacologic tools available only at this institution will be utilized in these trials, and these trials will significantly advance the aims of the Center and our understanding of the pharmacology of pain in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: PREDICTION OF DRUG INTERACTIONS IN VIVO AND IN VITRO Principal Investigator & Institution: Trager, William F.; Professor; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002 Summary: The recent successes of in vivo-in vitro correlations for metabolically based drug interactions suggests that enzyme behavior is largely conserved. However, current approaches to the prediction of inhibition based interactions have remained essentially qualitative. For numerous inhibitors, inhibition constants determined in vitro do not adequately predict the extent of interaction in vivo. These inhibitors appear to be more potent in vivo than in vitro. A fundamental problem in the field of in vitro-in vivo correlations is the absence of a general methodology for obtaining the concentration of inhibitor at the enzyme site and the inhibition constant that actually prevails at the site. In the present application, we will test the "free drug hypothesis," i.e. the concept that inhibitor effect is governed by unbound inhibitor at the actual site of the enzyme. In the first two specific aims, we will demonstrate that the free drug hypothesis is valid for competitive inhibitors in in vitro systems so long as unbound concentrations are
20
Fentanyl
measured using an extensive list of inhibitors with different protein binding and lipophilicity characteristics. Specific Aims 2(a) and 2(b) will test the validity of the "free drug hypothesis" in vivo. This will be accomplished using a new parameter, the "inhibition constants ratio" (R/kI). Theory suggests that this ratio (defined as K/i/(pre) determined in a purified recombinant system divided by the K/i/iv determined in vivo) will equal one and that it will be independent of enzyme. This proposal will thus provide a useful framework to effectuate quantitative in vivo predictions from data derived in vitro. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PROTEIN KINASE IN OPIOID RECEPTOR REGULATION & TOLERANCE Principal Investigator & Institution: Yoburn, Byron C.; Professor of Pharmacology; Pharmaceutical Sciences; St. John's University Jamaica, Ny 11439 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2004 Summary: The overall objective of this project is to examine the pathways that mediate mu-opioid receptor regulation and opioid tolerance in the intact animal. It has been established that opioid agonists differ in their ability to regulate CNS mu-opioid receptors in vivo. Chronic treatment with high intrinsic efficacy opioid agonists (e.g., etorphine) downregulates mu opioid receptors, while at the same time producing tolerance and regulation of mu-opioid receptor mRNA levels. Chronic treatment with lower intrinsic efficacy opioid agonists (e.g., morphine) can induce tolerance without altering mu-receptor density or mu-receptor mRNA. At present, the basis for the different effects of treatment with high and low intrinsic efficacy opioid agonists in vivo are not known. However, compelling data raise the possibility that opioid tolerance and mu-opioid receptor regulation require the activation of different intracellular signaling systems. This project will test the hypothesis that opioid agonist-induced downregulation of mu-opioid receptors and regulation of mu-opioid receptor mRNA levels in vivo involves three signaling proteins: G-protein receptor kinase 2,beta arrestin 2 and dynamin. It is further hypothesized that morphine-induced tolerance is independent of this signaling pathway in vivo. Finally, it is hypothesized that the magnitude of opioid tolerance is increased by mu-opioid receptor downregulation. The experiments proposed in this application will use behavioral, biochemical and molecular pharmacological methods to determine the role of these proteins in mediating opioid agonist-induced tolerance, downregulation of mu-opioid receptors and regulation of mu- receptor mRNA in vivo. The results of these studies will significantly enhance our knowledge of the pathways that regulate chronic opioid effects in the intact, behaving animal. As such, these results may provide important insights for developing strategies to treat opioid drug abuse and pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: PULMONARY UPTAKE AND KINETICS OF IV ANESTHETICS Principal Investigator & Institution: Henthorn, Thomas K.; Associate Professor and Director of Rese; Anesthesiology; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 01-MAY-1992; Project End 29-SEP-2004 Summary: (Adapted from the abstract) The investigators have demonstrated that fentanyl and verapamil are substrates of two distinct transporters at the blood-brain barrier: an efflux transporter, P-glycoprotein (P-gp), and an unidentified uptake
Studies
21
transporter. The proposed work will study the pharmacology of these endothelial mechanisms. Kinetic studies using cultured endothelial cells derived from lung and brain will investigate the extent to which the partitioning of opioid anesthetic drugs into or away from these tissues is mediated by drug transporters, and what drugs or factors influence them. Isolated perfused rat lung studies will be conducted to determine the contribution of the lung tissue matrix to the pharmacokinetics of drug distribution, and to further validate models of pulmonary uptake developed as part of the in vivo recirculatory pharmacokinetic models. Pharmacokinetic-pharmacodynamic studies of CNS effects of synthetic opioid drugs will be performed in an in vivo rat EEG paradigm and correlated to analgesia. Treatment will consist of blockade of either endothelial drug uptake or efflux functions. These experiments will describe any changes in the speed of onset and offset of drug effect and the sensitivity of the brain to opioid due to changes in drug transporter function. These experiments are designed to differentiate changes in pharmacokinetics produced by transporter blockade in the body as a whole (specifically the lung) from changes at the brain effect site. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RAPID MEDICATIONS
TRANSDERMAL
DELIVERY
OF
OPIOID
PAIN
Principal Investigator & Institution: Smith, Alan M.; Altea Therapeutics Corporation Tucker, Ga 30084 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 14-JAN-2003 Summary: (provided by applicant): The American Medical Association reports that undertreatment of pain is a major problem for cancer patients as well as for other disease conditions. Approximately 50-75% of cancer patients have pain that is undertreated, and 25% die in severe unrelieved pain. Noninvasive pain medication delivery systems are ideally suited to improve the quality of life for those who experience chronic pain. Currently available noninvasive systems are slow, variable, or require frequent dosing. The goal of this project is to demonstrate the capability of a novel thermal microporation method to enable rapid infusion of pain medication through the skin. The microporation method is a noninvasive, painless, needless, patchbased system which creates an array of microscopic openings in the stratum corneum that increases the drug flux significantly compared to drugs delivered through intact skin. Four top opioid candidates for microporation delivery will be evaluated with an in vitro drug delivery model system that involves studying freshly harvested hairless mouse skin to determine optimal formulation and microporation delivery parameters. The opioid candidates to be tested in vitro with the thermal microporation method include morphine, hydromorphone, fentanyl, and alfentanil. A small pilot clinical study will also be performed to determine the feasibility of delivering fentanyl with a commercially available transdermal patch in conjunction with the microporation system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SUBCUTANEOUS INFUSION OF SUFENTANIL CITRATE FOR PAIN Principal Investigator & Institution: Palmer, Pamela A.; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
22
•
Fentanyl
Project Title: TRANSMUCOSAL FENTANYL & MIDAZOLAM IN LACERATION REPAIR Principal Investigator & Institution: Klein, Eileen; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002 Summary: In an attempt to decrease the anxiety of procedures such as laceration repair in the ER, sedation has been used in addition to local anesthesia. Oral midazolam alone is only effective some of the time.This study proposes to compare the use of midazolam alone with midazolam in conjunction with transmucosal fentanyl for anxiety reduction during laceration repair. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: UNIVERSITY OF UTAH PEDIATRIC PHARMACOLOGY RESEARCH UNIT Principal Investigator & Institution: Ward, Robert M.; Pediatrics; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2004; Project Start 15-FEB-2004; Project End 31-DEC-2008 Summary: (provided by applicant): This is an application to become a member of the NICHD Pediatric Pharmacology Research Unit Network to increase the study of medications in pediatric subjects, increase understanding of developmental changes in drug metabolism, and increase labeling of drugs for the pediatric population. As part of this application, we propose to study the pharmacokinetics of morphine and its metabolism into glucuronides during a 72 hr infusion. The efficacy of morphine will be determined with validated pain scales and bispectral analysis of infant EEG. Another study proposes a randomized, blinded comparison of the development of tolerance and abstinence during treatment of neonates with fentanyl and morphine for sedation and analgesia during mechanical ventilation. Predictors of tolerance will be determined based on pharmacologic measures of exposure. The effectiveness of clonidine for treatment of abstinence syndrome in neonates will be determined in an open-label treatment. A third study will determine the systemic exposure to local anesthetics contained in the S-Caine topical local anesthetic patch. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “fentanyl” (or synonyms) into the search box. This search gives you access to full-
3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
Studies
23
text articles. The following is a sample of items found for fentanyl in the PubMed Central database: •
A randomized, placebo controlled, trial of preoperative sustained release Betamethasone plus non-controlled intraoperative Ketorolac or Fentanyl on pain after diagnostic laparoscopy or laparoscopic tubal ligation [ISRCTN52633712]. by Bagley WP, Smith AA, Hebert JD, Snider CC, Sega GA, Piller MD, Carney PC, Carroll RC.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=194702
•
Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain. by Allan L, Hays H, Jensen NH, de Waroux BL, Bolt M, Donald R, Kalso E.; 2001 May 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31593
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with fentanyl, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “fentanyl” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for fentanyl (hyperlinks lead to article summaries): •
A combination of alfentanil-lidocaine-propofol provides better intubating conditions than fentanyl-lidocaine-propofol in the absence of muscle relaxants. Author(s): Jabbour-Khoury SI, Dabbous AS, Rizk LB, Abou Jalad NM, Bartelmaos TE, El-Khatib MF, Baraka AS. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2003 February; 50(2): 116-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12560299&dopt=Abstract
•
A comparison of anaesthetic techniques for shock wave lithotripsy: the use of a remifentanil infusion alone compared to intermittent fentanyl boluses combined with a low dose propofol infusion. Author(s): Burmeister MA, Brauer P, Wintruff M, Graefen M, Blanc I, Standl TG. Source: Anaesthesia. 2002 September; 57(9): 877-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190752&dopt=Abstract
6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
24
Fentanyl
•
A comparison of fentanyl and sufentanil in patients undergoing coronary artery bypass graft surgery. Author(s): Thomson IR, Harding G, Hudson RJ. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2000 December; 14(6): 652-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11139103&dopt=Abstract
•
A comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia. Author(s): Engoren M, Luther G, Fenn-Buderer N. Source: Anesthesia and Analgesia. 2001 October; 93(4): 859-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574346&dopt=Abstract
•
A comparison of intrathecal fentanyl and sufentanil for labor analgesia. Author(s): Nelson KE, Rauch T, Terebuh V, D'Angelo R. Source: Anesthesiology. 2002 May; 96(5): 1070-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11981144&dopt=Abstract
•
A comparison of minidose lidocaine-fentanyl spinal anesthesia and local anesthesia/propofol infusion for outpatient knee arthroscopy. Author(s): Ben-David B, DeMeo PJ, Lucyk C, Solosko D. Source: Anesthesia and Analgesia. 2001 August; 93(2): 319-25, 2Nd Contents Page. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11473852&dopt=Abstract
•
A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children. Author(s): Howell TK, Smith S, Rushman SC, Walker RW, Radivan F. Source: Anaesthesia. 2002 August; 57(8): 798-805. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12133094&dopt=Abstract
•
A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care. Author(s): Sharar SR, Carrougher GJ, Selzer K, O'Donnell F, Vavilala MS, Lee LA. Source: The Journal of Burn Care & Rehabilitation. 2002 January-February; 23(1): 27-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11803309&dopt=Abstract
•
A comparison of remifentanil and fentanyl for fast track paediatric cardiac anaesthesia. Author(s): Friesen RH, Veit AS, Archibald DJ, Campanini RS. Source: Paediatric Anaesthesia. 2003 February; 13(2): 122-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12562484&dopt=Abstract
Studies
25
•
A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study. Author(s): Joshi GP, Warner DS, Twersky RS, Fleisher LA. Source: Journal of Clinical Anesthesia. 2002 November; 14(7): 494-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12477583&dopt=Abstract
•
A ketamine, fentanyl, and midazolam infusion for uncontrolled terminal pain and agitation. Author(s): Enck RE. Source: Am J Hosp Palliat Care. 2000 March-April; 17(2): 76-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11406960&dopt=Abstract
•
A new formulation of nasal fentanyl spray for postoperative analgesia: a pilot study. Author(s): Paech MJ, Lim CB, Banks SL, Rucklidge MW, Doherty DA. Source: Anaesthesia. 2003 August; 58(8): 740-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12859464&dopt=Abstract
•
A one year health economic model comparing transdermal fentanyl with sustainedrelease morphine in the treatment of chronic noncancer pain. Author(s): Frei A, Andersen S, Hole P, Jensen NH. Source: Journal of Pain & Palliative Care Pharmacotherapy. 2003; 17(2): 5-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14649386&dopt=Abstract
•
A pharmacokinetic study to compare two simultaneous 400 microg doses with a single 800 microg dose of oral transmucosal fentanyl citrate. Author(s): Lee M, Kern SE, Kisicki JC, Egan TD. Source: Journal of Pain and Symptom Management. 2003 August; 26(2): 743-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12906959&dopt=Abstract
•
A pitfall to avoid when starting a patient on transdermal fentanyl. Author(s): Low JA, Chye R. Source: Aust Fam Physician. 2000 December; 29(12): 1173-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11140227&dopt=Abstract
•
A randomized controlled trial of fentanyl for abortion pain. Author(s): Rawling MJ, Wiebe ER. Source: American Journal of Obstetrics and Gynecology. 2001 July; 185(1): 103-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11483912&dopt=Abstract
26
Fentanyl
•
A randomized trial of caudal block with bupivacaine 4 mg x kg-1 (1.8 ml x kg-1) plus morphine (150 microg x kg-1) vs general anaesthesia with fentanyl for cardiac surgery. Author(s): Rojas-Perez E, Castillo-Zamora C, Nava-Ocampo AA. Source: Paediatric Anaesthesia. 2003 May; 13(4): 311-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12753443&dopt=Abstract
•
A randomized, clinical trial of oral midazolam plus placebo versus oral midazolam plus oral transmucosal fentanyl for sedation during laceration repair. Author(s): Klein EJ, Diekema DS, Paris CA, Quan L, Cohen M, Seidel KD. Source: Pediatrics. 2002 May; 109(5): 894-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986452&dopt=Abstract
•
A randomized, double-blinded trial of subarachnoid bupivacaine and fentanyl, with or without clonidine, for combined spinal/epidural analgesia during labor. Author(s): Paech MJ, Banks SL, Gurrin LC, Yeo ST, Pavy TJ. Source: Anesthesia and Analgesia. 2002 November; 95(5): 1396-401, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401632&dopt=Abstract
•
A safe and effective method for converting cancer patients from intravenous to transdermal fentanyl. Author(s): Kornick CA, Santiago-Palma J, Khojainova N, Primavera LH, Payne R, Manfredi PL. Source: Cancer. 2001 December 15; 92(12): 3056-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753984&dopt=Abstract
•
A safe and effective method for converting patients from transdermal to intravenous fentanyl for the treatment of acute cancer-related pain. Author(s): Kornick CA, Santiago-Palma J, Schulman G, O'Brien PC, Weigand S, Payne R, Manfredi PL. Source: Cancer. 2003 June 15; 97(12): 3121-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12784350&dopt=Abstract
•
A small preoperative test dose of intravenous fentanyl can predict subsequent analgesic efficacy and incidence of side effects in patients due to receive epidural fentanyl. Author(s): Ueta K, Takeda K, Ohsumi H, Haruna J, Shibuya H, Mashimo T. Source: Anesthesia and Analgesia. 2003 April; 96(4): 1079-82, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12651664&dopt=Abstract
•
Abdominal pressure during laparoscopy: effects of fentanyl. Author(s): Drummond GB, Duncan MK. Source: British Journal of Anaesthesia. 2002 March; 88(3): 384-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11990271&dopt=Abstract
Studies
27
•
Addition of bupivacaine 1.25 mg to fentanyl confers no advantage over fentanyl alone for intrathecal analgesia in early labour. Author(s): Lim EH, Sia AT, Wong K, Tan HM. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 January; 49(1): 57-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11782329&dopt=Abstract
•
Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block. Author(s): Karakaya D, Buyukgoz F, Baris S, Guldogus F, Tur A. Source: Regional Anesthesia and Pain Medicine. 2001 September-October; 26(5): 434-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11561263&dopt=Abstract
•
Additional variables in the appropriateness of fentanyl. Author(s): Knowlton HL. Source: Am J Hosp Palliat Care. 2001 May-June; 18(3): 160. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11406891&dopt=Abstract
•
Adenotonsillectomy in children: a comparison of morphine and fentanyl for perioperative analgesia. Author(s): Mukherjee K, Esuvaranathan V, Streets C, Johnson A, Carr AS. Source: Anaesthesia. 2001 December; 56(12): 1193-7. Erratum In: Anaesthesia 2002 February; 57(2): 208. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11736779&dopt=Abstract
•
Altered level of consciousness after combined spinal-epidural labor analgesia with intrathecal fentanyl and bupivacaine. Author(s): Scavone BM. Source: Anesthesiology. 2002 April; 96(4): 1021-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11964613&dopt=Abstract
•
An outcome study comparing intravenous sedation with midazolam/fentanyl (conscious sedation) versus propofol infusion (deep sedation) for aesthetic surgery. Author(s): Hasen KV, Samartzis D, Casas LA, Mustoe TA. Source: Plastic and Reconstructive Surgery. 2003 November; 112(6): 1683-9; Discussion 1690-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14578803&dopt=Abstract
•
Anesthesia with ketamine, propofol, and fentanyl decreases the frequency of postoperative psychosis emergence and confusion in schizophrenic patients. Author(s): Kudoh A, Katagai H, Takazawa T. Source: Journal of Clinical Anesthesia. 2002 March; 14(2): 107-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11943522&dopt=Abstract
28
Fentanyl
•
Benefit-risk assessment of transdermal fentanyl for the treatment of chronic pain. Author(s): Kornick CA, Santiago-Palma J, Moryl N, Payne R, Obbens EA. Source: Drug Safety : an International Journal of Medical Toxicology and Drug Experience. 2003; 26(13): 951-73. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14583070&dopt=Abstract
•
Biasing effect of the electromyogram on BIS: a controlled study during high-dose fentanyl induction. Author(s): Renna M, Wigmore T, Mofeez A, Gillbe C. Source: Journal of Clinical Monitoring and Computing. 2002 August; 17(6): 377-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885182&dopt=Abstract
•
Bispectral index monitoring during infant cardiac surgery: relationship of BIS to the stress response and plasma fentanyl levels. Author(s): Kussman BD, Gruber EM, Zurakowski D, Hansen DD, Sullivan LJ, Laussen PC. Source: Paediatric Anaesthesia. 2001 November; 11(6): 663-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11696141&dopt=Abstract
•
Bispectral index-derived facial electromyography-guided fentanyl titration in the opiate-exposed patient. Author(s): Mathews DM, Kumaran KR, Neuman GG. Source: Anesthesia and Analgesia. 2003 April; 96(4): 1062-4, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12651661&dopt=Abstract
•
Bladder retention of urine as a result of continuous intravenous infusion of fentanyl: 2 case reports. Author(s): Das UG, Sasidharan P. Source: Pediatrics. 2001 October; 108(4): 1012-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11581460&dopt=Abstract
•
Blunted prolactin response to fentanyl in depression. Normalizing effect of partial sleep deprivation. Author(s): Frecska E, Perenyi A, Arato M. Source: Psychiatry Research. 2003 May 30; 118(2): 155-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798980&dopt=Abstract
•
Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Author(s): Coluzzi PH, Schwartzberg L, Conroy JD, Charapata S, Gay M, Busch MA, Chavez J, Ashley J, Lebo D, McCracken M, Portenoy RK. Source: Pain. 2001 March; 91(1-2): 123-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11240084&dopt=Abstract
Studies
29
•
Breakthrough strong opioid analgesia prescription in patients using transdermal fentanyl admitted to a hospice. Author(s): Lawrie I, Lloyd-Williams M, Waterhouse E. Source: Am J Hosp Palliat Care. 2003 May-June; 20(3): 229-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785045&dopt=Abstract
•
Breath interval as a continuous measure of opioid effects of intravenous fentanyl and alfentanil. Author(s): Smart JA, Pallett EJ, Duthie DJ. Source: European Journal of Anaesthesiology. 2003 June; 20(6): 498-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803272&dopt=Abstract
•
Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Author(s): Choi DH, Ahn HJ, Kim MH. Source: Regional Anesthesia and Pain Medicine. 2000 May-June; 25(3): 240-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10834777&dopt=Abstract
•
Calculating the cost for drug treatment including the adverse drug reactions treatment cost (primer for fentanyl TTS in Bulgaria). Author(s): Petrova GI, Getov IN. Source: Boll Chim Farm. 2002 March-April; 141(2): 150-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135164&dopt=Abstract
•
Cardiopulmonary bypass has minimal effects on the pharmacokinetics of fentanyl in adults. Author(s): Hudson RJ, Thomson IR, Jassal R, Peterson DJ, Brown AD, Freedman JI. Source: Anesthesiology. 2003 October; 99(4): 847-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508316&dopt=Abstract
•
Care of the dying: is pain control compromised or enhanced by continuation of the fentanyl transdermal patch in the dying phase? Author(s): Ellershaw JE, Kinder C, Aldridge J, Allison M, Smith JC. Source: Journal of Pain and Symptom Management. 2002 October; 24(4): 398-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12505208&dopt=Abstract
•
Cephalad movement of morphine and fentanyl in humans after intrathecal injection. Author(s): Eisenach JC, Hood DD, Curry R, Shafer SL. Source: Anesthesiology. 2003 July; 99(1): 166-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826857&dopt=Abstract
30
Fentanyl
•
Changes in cortical electrical activity during induction of anaesthesia with thiopental/fentanyl and tracheal intubation: a quantitative electroencephalographic analysis. Author(s): Rundshagen I, Schroder T, Prichep LS, John ER, Kox WJ. Source: British Journal of Anaesthesia. 2004 January; 92(1): 33-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14665550&dopt=Abstract
•
Choice of opioid for initiation of combined spinal epidural analgesia in labour-fentanyl or diamorphine. Author(s): Vaughan DJ, Ahmad N, Lillywhite NK, Lewis N, Thomas D, Robinson PN. Source: British Journal of Anaesthesia. 2001 April; 86(4): 567-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11573634&dopt=Abstract
•
Co-administration of alfentanil-propofol improves laryngeal mask airway insertion compared to fentanyl-propofol. Author(s): Hui JK, Critchley LA, Karmakar MK, Lam PK. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 May; 49(5): 508-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11983670&dopt=Abstract
•
Combination of intrathecal and intravenous fentanyl for cesarean delivery. Author(s): Kotake Y, Matsumoto M, Morisaki H, Takeda J. Source: Journal of Anesthesia. 2003; 17(4): 277-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14625718&dopt=Abstract
•
Comparative effects of propofol versus fentanyl on cerebral oxygenation state during normothermic cardiopulmonary bypass and postoperative cognitive dysfunction. Author(s): Kadoi Y, Saito S, Kunimoto F, Goto F, Fujita N. Source: The Annals of Thoracic Surgery. 2003 March; 75(3): 840-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12645704&dopt=Abstract
•
Comparative efficacy and safety of remifentanil and fentanyl in 'fast track' coronary artery bypass graft surgery: a randomized, double-blind study. Author(s): Mollhoff T, Herregods L, Moerman A, Blake D, MacAdams C, Demeyere R, Kirno K, Dybvik T, Shaikh S; Remifentanil Study Group. Source: British Journal of Anaesthesia. 2001 November; 87(5): 718-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11878522&dopt=Abstract
Studies
31
•
Comparison between repeat bolus intrathecal morphine and an epidurally delivered bupivacaine and fentanyl combination in the management of post-thoracotomy pain with or without cyclooxygenase inhibition. Author(s): McCrory C, Diviney D, Moriarty J, Luke D, Fitzgerald D. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2002 October; 16(5): 607-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407615&dopt=Abstract
•
Comparison of bupivacaine 0.2% and ropivacaine 0.2% combined with fentanyl for epidural analgesia during labour. Author(s): Asik I, Goktug A, Gulay I, Alkis N, Uysalel A. Source: European Journal of Anaesthesiology. 2002 April; 19(4): 263-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12074415&dopt=Abstract
•
Comparison of effects of remifentanil, alfentanil and fentanyl on cardiovascular responses to tracheal intubation in morbidly obese patients. Author(s): Salihoglu Z, Demiroluk S, Demirkiran, Kose Y. Source: European Journal of Anaesthesiology. 2002 February; 19(2): 125-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11999595&dopt=Abstract
•
Comparison of fentanyl and nalbuphine in total intravenous anaesthesia (TIVA). Author(s): Khan FA, Hameedullah. Source: J Pak Med Assoc. 2002 October; 52(10): 459-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12553675&dopt=Abstract
•
Comparison of fentanyl-bupivacaine or midazolam-bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children. Author(s): Baris S, Karakaya D, Kelsaka E, Guldogus F, Ariturk E, Tur A. Source: Paediatric Anaesthesia. 2003 February; 13(2): 126-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12562485&dopt=Abstract
•
Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for caesarean section under spinal anaesthesia. Author(s): Cowan CM, Kendall JB, Barclay PM, Wilkes RG. Source: British Journal of Anaesthesia. 2002 September; 89(3): 452-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12402725&dopt=Abstract
•
Comparison of patient-controlled epidural bolus administration of 0.1% ropivacaine and 0.1% levobupivacaine, both with 0.0002% fentanyl, for analgesia during labour. Author(s): Purdie NL, McGrady EM. Source: Anaesthesia. 2004 February; 59(2): 133-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14725515&dopt=Abstract
32
Fentanyl
•
Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department. Author(s): Godambe SA, Elliot V, Matheny D, Pershad J. Source: Pediatrics. 2003 July; 112(1 Pt 1): 116-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12837876&dopt=Abstract
•
Comparison of remifentanil and fentanyl in patients undergoing modified radical mastectomy or total hysterectomy. Author(s): Guo X, Yi J, Ye T, Luo A, Huang Y, Ren H. Source: Chinese Medical Journal. 2003 September; 116(9): 1386-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14527372&dopt=Abstract
•
Comparison of ropivacaine-fentanyl patient-controlled epidural analgesia with morphine intravenous patient-controlled analgesia for perioperative analgesia and recovery after open colon surgery. Author(s): Steinberg RB, Liu SS, Wu CL, Mackey DC, Grass JA, Ahlen K, Jeppsson L. Source: Journal of Clinical Anesthesia. 2002 December; 14(8): 571-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12565114&dopt=Abstract
•
Comparison of sevoflurane-nitrous oxide and target-controlled propofol with fentanyl anesthesia for hysteroscopy. Author(s): Hong JY, Oh JI, Kim SM. Source: Yonsei Medical Journal. 2002 August; 43(4): 420-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12205728&dopt=Abstract
•
Comparison of sufentanil and fentanyl for surgical repair of congenital cardiac defects. Author(s): Prakanrattana U, Suksompong S. Source: J Med Assoc Thai. 2002 September; 85 Suppl 3: S807-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452216&dopt=Abstract
•
Comparison of the effects of remifentanil or fentanyl on anaesthetic induction characteristics of propofol, thiopental or etomidate. Author(s): Wilhelm W, Biedler A, Huppert A, Kreuer S, Bucheler O, Ziegenfuss T, Larsen R. Source: European Journal of Anaesthesiology. 2002 May; 19(5): 350-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12095015&dopt=Abstract
Studies
33
•
Comparison of total intravenous anesthesia and sevoflurane-fentanyl anesthesia for outpatient otorhinolaryngeal surgery. Author(s): Montes FR, Trillos JE, Rincon IE, Giraldo JC, Rincon JD, Vanegas MV, Charris H. Source: Journal of Clinical Anesthesia. 2002 August; 14(5): 324-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12208434&dopt=Abstract
•
Comparison of TTS-fentanyl with sustained-release oral morphine in the treatment of patients not using opioids for mild-to-moderate pain. Author(s): van Seventer R, Smit JM, Schipper RM, Wicks MA, Zuurmond WW. Source: Current Medical Research and Opinion. 2003; 19(6): 457-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14594516&dopt=Abstract
•
Conditions for insertion of the laryngeal mask airway: comparisons between sevoflurane and propofol using fentanyl as a co-induction agent. A pilot study. Author(s): Ganatra SB, D'Mello J, Butani M, Jhamnani P. Source: European Journal of Anaesthesiology. 2002 May; 19(5): 371-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12095019&dopt=Abstract
•
Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy. Author(s): Rudner R, Jalowiecki P, Kawecki P, Gonciarz M, Mularczyk A, Petelenz M. Source: Gastrointestinal Endoscopy. 2003 May; 57(6): 657-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709693&dopt=Abstract
•
Conscious sedation with intermittent midazolam and fentanyl in electrophysiology procedures. Author(s): Pachulski RT, Adkins DC, Mirza H. Source: Journal of Interventional Cardiology. 2001 April; 14(2): 143-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12053295&dopt=Abstract
•
Cortisol response to surgery and postoperative confusion in depressed patients under general anesthesia with fentanyl. Author(s): Kudoh A, Takahira Y, Katagai H, Takazawa T. Source: Neuropsychobiology. 2002; 46(1): 22-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12207143&dopt=Abstract
•
Cost analysis of fentanyl and remifentanil in coronary artery bypass graft surgery without cardiopulmonary bypass. Author(s): Reddy P, Feret BM, Kulicki L, Donahue S, Quercia RA. Source: Journal of Clinical Pharmacy and Therapeutics. 2002 April; 27(2): 127-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975697&dopt=Abstract
34
Fentanyl
•
Diluent volume for epidural fentanyl and its effect on analgesia in early labor. Author(s): Connelly NR, Parker RK, Pedersen T, Manikantan T, Lucas T, Serban S, ElMansouri M, DuBois S, Santos ED, Rizvi A, Gibson C. Source: Anesthesia and Analgesia. 2003 June; 96(6): 1799-804, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761015&dopt=Abstract
•
Do patients prefer transdermal fentanyl or sustained-release oral morphine for treatment of chronic non-cancer pain? Author(s): Heidemann AJ, Seaton TL. Source: The Journal of Family Practice. 2001 October; 50(10): 897. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11674896&dopt=Abstract
•
Does adrenaline improve epidural bupivacaine and fentanyl analgesia after abdominal surgery? Author(s): Breivik H, Niemi G. Source: Anaesthesia and Intensive Care. 2001 August; 29(4): 436-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11512659&dopt=Abstract
•
Does adrenaline improve epidural bupivacaine and fentanyl analgesia after abdominal surgery? Author(s): Sakaguchi Y, Sakura S, Shinzawa M, Saito Y. Source: Anaesthesia and Intensive Care. 2000 October; 28(5): 522-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11094667&dopt=Abstract
•
Does functional ability in the postoperative period differ between remifentanil- and fentanyl-based anesthesia? Author(s): Fleisher LA, Hogue S, Colopy M, Twersky RS, Warner DS, Jamerson BD, Tuman KJ, Glass PS, Roizen MF. Source: Journal of Clinical Anesthesia. 2001 September; 13(6): 401-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11578882&dopt=Abstract
•
Does the addition of fentanyl to bupivacaine in caudal epidural block have an effect on the plasma level of catecholamines in children? Author(s): Gaitini LA, Somri M, Vaida SJ, Yanovski B, Mogilner G, Sabo E, Lischinsky S, Greenberg A, Levy N, Zinder O. Source: Anesthesia and Analgesia. 2000 May; 90(5): 1029-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10781448&dopt=Abstract
•
Driving ability under long-term treatment with transdermal fentanyl. Author(s): Sabatowski R, Schwalen S, Rettig K, Herberg KW, Kasper SM, Radbruch L. Source: Journal of Pain and Symptom Management. 2003 January; 25(1): 38-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12565187&dopt=Abstract
Studies
35
•
Duragesic transdermal patch: postmortem tissue distribution of fentanyl in 25 cases. Author(s): Anderson DT, Muto JJ. Source: Journal of Analytical Toxicology. 2000 October; 24(7): 627-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11043670&dopt=Abstract
•
Economic evaluation of the fentanyl transdermal system for the treatment of chronic moderate to severe pain. Author(s): Neighbors DM, Bell TJ, Wilson J, Dodd SL. Source: Journal of Pain and Symptom Management. 2001 February; 21(2): 129-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11226764&dopt=Abstract
•
Effect of a single dose of esmolol on the bispectral index scale (BIS) during propofol/fentanyl anaesthesia. Author(s): Berkenstadt H, Loebstein R, Faibishenko I, Halkin H, Keidan I, Perel A. Source: British Journal of Anaesthesia. 2002 September; 89(3): 509-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12402733&dopt=Abstract
•
Effect of continuous low-dose intravenous diltiazem on epidural fentanyl analgesia after lower abdominal surgery. Author(s): Nitahara K, Matsunaga M, Katori K, Yotsui H, Higuchi H, Higa K. Source: British Journal of Anaesthesia. 2003 April; 90(4): 507-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12644426&dopt=Abstract
•
Effect of intrathecal fentanyl on oxytocin secretion in pregnant women not in labour. Author(s): Shibli KU, Dhillon AR, Goode JA, Gilbert CL, Thompson JW, Russell IF, Lindow SW. Source: Clinical Science (London, England : 1979). 2001 October; 101(4): 415-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11566079&dopt=Abstract
•
Effect of midazolam pretreatment on induction dose requirements of propofol in combination with fentanyl in younger and older adults. Author(s): Cressey DM, Claydon P, Bhaskaran NC, Reilly CS. Source: Anaesthesia. 2001 February; 56(2): 108-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11167469&dopt=Abstract
•
Effect of remifentanil compared with fentanyl on intraocular pressure after succinylcholine and tracheal intubation. Author(s): Ng HP, Chen FG, Yeong SM, Wong E, Chew P. Source: British Journal of Anaesthesia. 2000 November; 85(5): 785-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11094598&dopt=Abstract
36
Fentanyl
•
Effectiveness of remifentanil versus traditional fentanyl-based anesthetic in high-risk outpatient surgery. Author(s): Mackey JJ, Parker SD, Nass CM, Snyder DS, Curreri S, Kazim D, Zuckerman RL, Fleisher LA. Source: Journal of Clinical Anesthesia. 2000 September; 12(6): 427-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11090727&dopt=Abstract
•
Effects of adding epinephrine plus fentanyl to low-dose lidocaine for spinal anesthesia in outpatient knee arthroscopy. Author(s): Turker G, UCkunkaya N, Yilmazlar A, Demirag B, Tokat O. Source: Acta Anaesthesiologica Scandinavica. 2003 September; 47(8): 986-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12904191&dopt=Abstract
•
Effects of fentanyl on pain and hemodynamic response after retrobulbar block in patients having phacoemulsification. Author(s): Inan UU, Sivaci RG, Ermis SS, Ozturk F. Source: Journal of Cataract and Refractive Surgery. 2003 June; 29(6): 1137-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842681&dopt=Abstract
•
Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaesthesia. Author(s): Lysakowski C, Dumont L, Pellegrini M, Clergue F, Tassonyi E. Source: British Journal of Anaesthesia. 2001 April; 86(4): 523-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11573626&dopt=Abstract
•
Effects of intravenous ketorolac and fentanyl combined with midazolam on analgesia and side effects during extracorporeal shock wave lithotripsy. Author(s): Yang CP, Cherng CH, Wong CS, Ho ST. Source: Acta Anaesthesiol Sin. 2002 March; 40(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11989050&dopt=Abstract
•
Effects of IV pentobarbital with and without fentanyl on end-tidal carbon dioxide levels during deep sedation of pediatric patients undergoing MRI. Author(s): Connor L, Burrows PE, Zurakowski D, Bucci K, Gagnon DA, Mason KP. Source: Ajr. American Journal of Roentgenology. 2003 December; 181(6): 1691-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14627598&dopt=Abstract
•
Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children. Author(s): Waters KA, McBrien F, Stewart P, Hinder M, Wharton S. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 2002 May; 92(5): 1987-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11960949&dopt=Abstract
Studies
37
•
Effect-site concentration of propofol for recovery of consciousness is virtually independent of fentanyl effect-site concentration. Author(s): Iwakiri H, Nagata O, Matsukawa T, Ozaki M, Sessler DI. Source: Anesthesia and Analgesia. 2003 June; 96(6): 1651-5, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760990&dopt=Abstract
•
Efficacy, safety, and pharmacokinetics of levobupivacaine with and without fentanyl after continuous epidural infusion in children: a multicenter trial. Author(s): Lerman J, Nolan J, Eyres R, Schily M, Stoddart P, Bolton CM, Mazzeo F, Wolf AR. Source: Anesthesiology. 2003 November; 99(5): 1166-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14576555&dopt=Abstract
•
Either sufentanil or fentanyl, in addition to intrathecal bupivacaine, provide satisfactory early labour analgesia. Author(s): Cheng CJ, Sia AT, Lim EH, Loke GP, Tan HM. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2001 June; 48(6): 570-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11444452&dopt=Abstract
•
Electrically modulated transdermal delivery of fentanyl. Author(s): Conjeevaram R, Banga AK, Zhang L. Source: Pharmaceutical Research. 2002 April; 19(4): 440-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12033377&dopt=Abstract
•
Enteral methadone to expedite fentanyl discontinuation and prevent opioid abstinence syndrome in the PICU. Author(s): Lugo RA, MacLaren R, Cash J, Pribble CG, Vernon DD. Source: Pharmacotherapy. 2001 December; 21(12): 1566-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11765307&dopt=Abstract
•
Eosinophilic pustular eruption associated with transdermal fentanyl. Author(s): Mancuso G, Berdondini RM, Passarini B. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 2001 January; 15(1): 70-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11451331&dopt=Abstract
•
Epidural bupivacaine with sufentanil or fentanyl during labour: a randomized, double-blind study. Author(s): Rolfseng OK, Skogvoll E, Borchgrevink PC. Source: European Journal of Anaesthesiology. 2002 November; 19(11): 812-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442931&dopt=Abstract
38
Fentanyl
•
Epidural fentanyl markedly improves thoracic epidural analgesia in a low-dose infusion of bupivacaine, adrenaline and fentanyl. A randomized, double-blind crossover study with and without fentanyl. Author(s): Niemi G, Breivik H. Source: Acta Anaesthesiologica Scandinavica. 2001 February; 45(2): 221-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11167169&dopt=Abstract
•
Epidural fentanyl speeds the onset of sensory block during epidural lidocaine anesthesia. Author(s): Cherng CH, Wong CS, Ho ST. Source: Regional Anesthesia and Pain Medicine. 2001 November-December; 26(6): 523-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11707790&dopt=Abstract
•
Epidural fentanyl-bupivacaine compared with clonidine-bupivacaine for analgesia in labour. Author(s): Kizilarslan S, Kuvaki B, Onat U, Sagiroglu E. Source: European Journal of Anaesthesiology. 2000 November; 17(11): 692-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11029568&dopt=Abstract
•
Epidural infusions for labor analgesia: a comparison of 0.2% ropivacaine, 0.1% ropivacaine, and 0.1% ropivacaine with fentanyl. Author(s): Lee BB, Ngan Kee WD, Lau WM, Wong AS. Source: Regional Anesthesia and Pain Medicine. 2002 January-February; 27(1): 31-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11799502&dopt=Abstract
•
Epinephrine added to a lumbar epidural infusion of a small-dose ropivacainefentanyl mixture after arterial bypass surgery of the lower extremities. Author(s): Forster JG, Niemi TT, Aromaa U, Neuvonen PJ, Seppala TA, Rosenberg PH. Source: Acta Anaesthesiologica Scandinavica. 2003 October; 47(9): 1106-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12969104&dopt=Abstract
•
Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia. Author(s): Goodman SR, Kim-Lo SH, Ciliberto CF, Ridley DM, Smiley RM. Source: Regional Anesthesia and Pain Medicine. 2002 July-August; 27(4): 374-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132061&dopt=Abstract
Studies
39
•
Epinephrine markedly improves thoracic epidural analgesia produced by a smalldose infusion of ropivacaine, fentanyl, and epinephrine after major thoracic or abdominal surgery: a randomized, double-blinded crossover study with and without epinephrine. Author(s): Niemi G, Breivik H. Source: Anesthesia and Analgesia. 2002 June; 94(6): 1598-605, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12032036&dopt=Abstract
•
E-TRANS fentanyl. ALZA. Author(s): Mystakidou K. Source: Curr Opin Investig Drugs. 2002 March; 3(3): 463-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12054098&dopt=Abstract
•
Explosive coughing after bolus fentanyl injection. Author(s): Tweed WA, Dakin D. Source: Anesthesia and Analgesia. 2001 June; 92(6): 1442-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11375822&dopt=Abstract
•
Extension of epidural blockade in labour for emergency Caesarean section using 2% lidocaine with epinephrine and fentanyl, with or without alkalinisation. Author(s): Lam DT, Ngan Kee WD, Khaw KS. Source: Anaesthesia. 2001 August; 56(8): 790-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11493247&dopt=Abstract
•
Facilitated uptake of fentanyl, but not alfentanil, by human pulmonary endothelial cells. Author(s): Waters CM, Krejcie TC, Avram MJ. Source: Anesthesiology. 2000 September; 93(3): 825-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10969317&dopt=Abstract
•
False-positive lysergic acid diethylamide immunoassay screen associated with fentanyl medication. Author(s): Gagajewski A, Davis GK, Kloss J, Poch GK, Anderson CJ, Apple FS. Source: Clinical Chemistry. 2002 January; 48(1): 205-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11751564&dopt=Abstract
•
Fatal intravenous misuse of transdermal fentanyl. Author(s): Reeves MD, Ginifer CJ. Source: The Medical Journal of Australia. 2002 November 18; 177(10): 552-3. Erratum In: Med J Aust. 2003 May 19; 178(10): 526. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12429004&dopt=Abstract
40
Fentanyl
•
Fentanyl abolishes the hyperdynamic response to isoflurane without affecting the change in bispectral index. Author(s): Nakayama M, Hayashi M, Kanaya N, Namiki A. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 December; 49(10): 1100-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12477690&dopt=Abstract
•
Fentanyl added to bupivacaine 0.05% or ropivacaine 0.05% in patient-controlled epidural analgesia in labour. Author(s): Pirbudak L, Tuncer S, Kocoglu H, Goksu S, Celik C. Source: European Journal of Anaesthesiology. 2002 April; 19(4): 271-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12074416&dopt=Abstract
•
Fentanyl and midazolam anaesthesia for coronary bypass surgery. Author(s): Absalom A, Nagels W. Source: British Journal of Anaesthesia. 2000 December; 85(6): 940-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11732542&dopt=Abstract
•
Fentanyl and midazolam anaesthesia for coronary bypass surgery: a clinical study of bispectral electroencephalogram analysis, drug concentrations and recall. Author(s): Barr G, Anderson RE, Samuelsson S, Owall A, Jakobsson JG. Source: British Journal of Anaesthesia. 2000 June; 84(6): 749-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10895750&dopt=Abstract
•
Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Author(s): Adachi YU, Satomoto M, Higuchi H, Watanabe K. Source: Anesthesia and Analgesia. 2002 July; 95(1): 233-7, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12088976&dopt=Abstract
•
Fentanyl augments block of sympathetic responses to skin incision during sevoflurane anaesthesia in children. Author(s): Katoh T, Kobayashi S, Suzuki A, Kato S, Iwamoto T, Bito H, Sato S. Source: British Journal of Anaesthesia. 2000 January; 84(1): 63-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10740549&dopt=Abstract
•
Fentanyl decreases propofol requirement for laryngeal mask airway insertion. Author(s): Goyagi T, Tanaka M, Nishikawa T. Source: Acta Anaesthesiologica Scandinavica. 2003 July; 47(6): 771-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803598&dopt=Abstract
Studies
41
•
Fentanyl does not improve the nerve block characteristics of axillary brachial plexus anaesthesia performed with ropivacaine. Author(s): Fanelli G, Casati A, Magistris L, Berti M, Albertin A, Scarioni M, Torri G. Source: Acta Anaesthesiologica Scandinavica. 2001 May; 45(5): 590-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11309009&dopt=Abstract
•
Fentanyl improves analgesia but prolongs the onset of axillary brachial plexus block by peripheral mechanism. Author(s): Nishikawa K, Kanaya N, Nakayama M, Igarashi M, Tsunoda K, Namiki A. Source: Anesthesia and Analgesia. 2000 August; 91(2): 384-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10910853&dopt=Abstract
•
Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children. Author(s): Abdallah C, Karsli C, Bissonnette B. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 December; 49(10): 1070-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12477681&dopt=Abstract
•
Fentanyl patches for the treatment of pain in dying cancer patients. Author(s): Jakobsson M, Strang P. Source: Anticancer Res. 1999 September-October; 19(5C): 4441-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10650789&dopt=Abstract
•
Fentanyl supplementation of sevoflurane induction of anaesthesia. Author(s): Plastow SE, Hall JE, Pugh SC. Source: Anaesthesia. 2000 May; 55(5): 475-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10792142&dopt=Abstract
•
Fentanyl transdermal system and oxycodone hydrochloride. Author(s): Seifeldin R, Grossman P. Source: J Manag Care Pharm. 2003 September-October; 9(5): 457; Authors' Reply 458-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14613448&dopt=Abstract
•
Fentanyl versus sufentanil: plasma concentrations during continuous epidural postoperative infusion in children. Author(s): Lejus C, Schwoerer D, Furic I, Le Moing JP, Levron JC, Pinaud M. Source: British Journal of Anaesthesia. 2000 October; 85(4): 615-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11064622&dopt=Abstract
42
Fentanyl
•
Fentanyl-associated syndrome of inappropriate antidiuretic hormone secretion. Author(s): Kokko H, Hall PD, Afrin LB. Source: Pharmacotherapy. 2002 September; 22(9): 1188-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12222557&dopt=Abstract
•
Fentanyl-induced chest wall rigidity and laryngospasm in preterm and term infants. Author(s): Fahnenstich H, Steffan J, Kau N, Bartmann P. Source: Critical Care Medicine. 2000 March; 28(3): 836-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10752838&dopt=Abstract
•
Fentanyl-induced coughing and airway hyperresponsiveness. Author(s): Tsou CH, Luk HN, Chiang SC, Hsin ST, Wang JH. Source: Acta Anaesthesiol Sin. 2002 December; 40(4): 165-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596614&dopt=Abstract
•
Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine. Author(s): Roy S, Fortier LP. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2003 January; 50(1): 32-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514147&dopt=Abstract
•
Fentanyl-mediated reduction in the bispectral index and 95% spectral edge frequency is age-dependent. Author(s): Anzawa N, Hirota K, Kitayama M, Kushikata T, Matsuki A. Source: European Journal of Anaesthesiology. 2003 February; 20(2): 167-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622506&dopt=Abstract
•
Fetuses, fentanyl, and the stress response: signals from the beginnings of pain? Author(s): Anand KJ, Maze M. Source: Anesthesiology. 2001 October; 95(4): 823-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11605918&dopt=Abstract
•
Flurbiprofen does not change the bispectral index and 95% spectral edge frequency during total intravenous anaesthesia with propofol and fentanyl. Author(s): Hirota K, Fukushi S, Baba S, Matsuki A. Source: European Journal of Anaesthesiology. 2002 July; 19(7): 483-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113610&dopt=Abstract
Studies
43
•
From codeine to transdermal fentanyl for cancer pain control: a safety and efficacy clinical trial. Author(s): Mystakidou K, Befon S, Kouskouni E, Gerolymatos K, Georgaki S, Tsilika E, Vlahos L. Source: Anticancer Res. 2001 May-June; 21(3C): 2225-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11501851&dopt=Abstract
•
Gastric emptying in post-thoracotomy patients receiving a thoracic fentanylbupivacaine epidural infusion. Author(s): Guha A, Scawn ND, Rogers SA, Pennefather SH, Russell GN. Source: European Journal of Anaesthesiology. 2002 September; 19(9): 652-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12243288&dopt=Abstract
•
Generalized muscle rigidity in a neonate following intrathecal fentanyl during caesarean delivery. Author(s): Bolisetty S, Kitchanan S, Whitehall J. Source: Intensive Care Medicine. 1999 November; 25(11): 1337. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10654227&dopt=Abstract
•
Gestational age and birth weight effects on plasma clearance of fentanyl in newborn infants. Author(s): Saarenmaa E, Neuvonen PJ, Fellman V. Source: The Journal of Pediatrics. 2000 June; 136(6): 767-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10839874&dopt=Abstract
•
Haemodynamic comparison of propofol-fentanyl anaesthesia with midazolamfentanyl anaesthesia in CABG patients without preoperative heart failure. Author(s): Kubota T, Hirota K, Yoshida H, Yatsu Y, Maeda A, Matsuki A. Source: Acta Anaesthesiol Belg. 2000; 51(3): 197-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11129620&dopt=Abstract
•
Halothane, isoflurane, and fentanyl increase the minimally effective defibrillation threshold of an implantable cardioverter defibrillator: first report in humans. Author(s): Weinbroum AA, Glick A, Copperman Y, Yashar T, Rudick V, Flaishon R. Source: Anesthesia and Analgesia. 2002 November; 95(5): 1147-53, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401582&dopt=Abstract
•
Heat-associated increase in transdermal fentanyl absorption. Author(s): Carter KA. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 January 15; 60(2): 191-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12561665&dopt=Abstract
44
Fentanyl
•
Hemodynamic stability, myocardial ischemia, and perioperative outcome after carotid surgery with remifentanil/propofol or isoflurane/fentanyl anesthesia. Author(s): Jellish WS, Sheikh T, Baker WH, Louie EK, Slogoff S. Source: Journal of Neurosurgical Anesthesiology. 2003 July; 15(3): 176-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826964&dopt=Abstract
•
Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients. Author(s): Twersky RS, Jamerson B, Warner DS, Fleisher LA, Hogue S. Source: Journal of Clinical Anesthesia. 2001 September; 13(6): 407-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11578883&dopt=Abstract
•
Hyperbaric bupivacaine 2.5 mg prolongs analgesia compared with plain bupivacaine when added to intrathecal fentanyl 25 microg in advanced labor. Author(s): Teoh WH, Sia AT. Source: Anesthesia and Analgesia. 2003 September; 97(3): 873-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933419&dopt=Abstract
•
Implementing sevoflurane anesthesia with small doses opioid for upper abdominal surgery. Postoperative respiratory function after either remifentanil or fentanyl. Author(s): Casati A, Albertin A, Danelli G, Deni F, Scarioni M, Santorsola R, Nucera D. Source: Minerva Anestesiol. 2001 September; 67(9): 621-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11731751&dopt=Abstract
•
In vitro study of low-frequency ultrasound-enhanced transdermal transport of fentanyl and caffeine across human and hairless rat skin. Author(s): Boucaud A, Machet L, Arbeille B, Machet MC, Sournac M, Mavon A, Patat F, Vaillant L. Source: International Journal of Pharmaceutics. 2001 October 9; 228(1-2): 69-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11576769&dopt=Abstract
•
Increased incidence of postoperative nausea and vomiting without additional analgesic effects when a low dose of intravenous fentanyl is combined with a caudal block. Author(s): Kokinsky E, Nilsson K, Larsson LE. Source: Paediatric Anaesthesia. 2003 May; 13(4): 334-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12753447&dopt=Abstract
Studies
45
•
Inefficacy of high-dose transdermal fentanyl in a patient with neuropathic pain, a case report. Author(s): Bleeker CP, Bremer RC, Dongelmans DA, van Dongen RT, Crul BJ. Source: European Journal of Pain (London, England). 2001; 5(3): 325-9; Discussion 32931. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11558988&dopt=Abstract
•
Interaction of morphine, fentanyl, sufentanil, alfentanil, and loperamide with the efflux drug transporter P-glycoprotein. Author(s): Wandel C, Kim R, Wood M, Wood A. Source: Anesthesiology. 2002 April; 96(4): 913-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11964599&dopt=Abstract
•
Interpretation of radial pulse contour during fentanyl/nitrous oxide anesthesia and mechanical ventilation. Author(s): Soderstrom S, Sellgren J, Aneman A, Ponten J. Source: Acta Anaesthesiologica Scandinavica. 2002 August; 46(7): 866-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12139544&dopt=Abstract
•
Intracranial pressure and cerebral hemodynamic in patients with cerebral tumors: a randomized prospective study of patients subjected to craniotomy in propofolfentanyl, isoflurane-fentanyl, or sevoflurane-fentanyl anesthesia. Author(s): Petersen KD, Landsfeldt U, Cold GE, Petersen CB, Mau S, Hauerberg J, Holst P, Olsen KS. Source: Anesthesiology. 2003 February; 98(2): 329-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12552189&dopt=Abstract
•
Intranasal fentanyl for postoperative analgesia after elective Caesarean section. Author(s): Wong P, Chadwick FD, Karovits J. Source: Anaesthesia. 2003 August; 58(8): 818-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12859501&dopt=Abstract
•
Intranasal fentanyl provides adequate postoperative analgesia in pediatric patients. Author(s): Manjushree R, Lahiri A, Ghosh BR, Laha A, Handa K. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 February; 49(2): 190-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11823399&dopt=Abstract
•
Intranasal fentanyl reduces acute pain in children in the emergency department: a safety and efficacy study. Author(s): Borland ML, Jacobs I, Geelhoed G. Source: Emergency Medicine (Fremantle, W.A.). 2002 September; 14(3): 275-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12487045&dopt=Abstract
46
Fentanyl
•
Intrathecal diamorphine or intrathecal fentanyl to supplement spinal anaesthesia for Caesarean section? Author(s): Cooper DW. Source: British Journal of Anaesthesia. 2003 January; 90(1): 107; Author Reply 107. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12488396&dopt=Abstract
•
Intrathecal fentanyl added to hyperbaric ropivacaine for cesarean delivery. Author(s): Chung CJ, Yun SH, Hwang GB, Park JS, Chin YJ. Source: Regional Anesthesia and Pain Medicine. 2002 November-December; 27(6): 600-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12430112&dopt=Abstract
•
Intrathecal fentanyl added to intrathecal bupivacaine for day case surgery: a randomized study. Author(s): Goel S, Bhardwaj N, Grover VK. Source: European Journal of Anaesthesiology. 2003 April; 20(4): 294-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703834&dopt=Abstract
•
Intrathecal fentanyl, sufentanil, or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective cesarean delivery. Author(s): Meininger D, Byhahn C, Kessler P, Nordmeyer J, Alparslan Y, Hall BA, Bremerich DH. Source: Anesthesia and Analgesia. 2003 March; 96(3): 852-8, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12598273&dopt=Abstract
•
Intrathecal fentanyl/meperidine combined with low-dose epidural bupivacaine for Cesarean section in a patient with advanced Krukenberg tumors. Author(s): Okutomi T, Hoshino Y, Amano K, Okamoto H, Hoka S. Source: Acta Anaesthesiologica Scandinavica. 2002 November; 46(10): 1272-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12421201&dopt=Abstract
•
Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 microg for outpatient knee arthroscopy with tourniquet. Author(s): Korhonen AM, Valanne JV, Jokela RM, Ravaska P, Korttila K. Source: Acta Anaesthesiologica Scandinavica. 2003 March; 47(3): 342-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648202&dopt=Abstract
•
Intrathecal magnesium prolongs fentanyl analgesia. Author(s): Arakawa M. Source: Anesthesia and Analgesia. 2003 May; 96(5): 1533; Author Reply 1533. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707174&dopt=Abstract
Studies
47
•
Intrathecal magnesium prolongs fentanyl analgesia: a prospective, randomized, controlled trial. Author(s): Buvanendran A, McCarthy RJ, Kroin JS, Leong W, Perry P, Tuman KJ. Source: Anesthesia and Analgesia. 2002 September; 95(3): 661-6, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12198056&dopt=Abstract
•
Intrathecal ropivacaine or bupivacaine with fentanyl for labour. Author(s): Pinder AJ, Dresner M. Source: British Journal of Anaesthesia. 2002 April; 88(4): 611; Author Reply 611-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12066753&dopt=Abstract
•
Intrathecal ropivacaine or bupivacaine with fentanyl for labour. Author(s): Hughes D, Hill D, Fee JP. Source: British Journal of Anaesthesia. 2001 November; 87(5): 733-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11878524&dopt=Abstract
•
Intrathecal versus intravenous fentanyl for supplementation of subarachnoid block during cesarean delivery. Author(s): Siddik-Sayyid SM, Aouad MT, Jalbout MI, Zalaket MI, Berzina CE, Baraka AS. Source: Anesthesia and Analgesia. 2002 July; 95(1): 209-13, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12088970&dopt=Abstract
•
Intrathecal versus IV fentanyl in pediatric cardiac anesthesia. Author(s): Pirat A, Akpek E, Arslan G. Source: Anesthesia and Analgesia. 2002 November; 95(5): 1207-14, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401595&dopt=Abstract
•
Intravenous alprostadil, an analog of prostaglandin E1, prevents thiamylal-fentanylinduced bronchoconstriction in humans. Author(s): Wajima Z, Shiga T, Yoshikawa T, Ogura A, Imanaga K, Inoue T, Ogawa R. Source: Anesthesia and Analgesia. 2003 August; 97(2): 456-60, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873934&dopt=Abstract
•
Intravenous colforsin daropate, a water-soluble forskolin derivative, prevents thiamylal-fentanyl-induced bronchoconstriction in humans. Author(s): Wajima Z, Yoshikawa T, Ogura A, Imanaga K, Shiga T, Inoue T, Ogawa R. Source: Critical Care Medicine. 2002 April; 30(4): 820-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11940752&dopt=Abstract
48
Fentanyl
•
Intravenous fentanyl for cancer pain: a “fast titration” protocol for the emergency room. Author(s): Soares LG, Martins M, Uchoa R. Source: Journal of Pain and Symptom Management. 2003 September; 26(3): 876-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14528871&dopt=Abstract
•
Intravenous fentanyl increases natural killer cell cytotoxicity and circulating CD16(+) lymphocytes in humans. Author(s): Yeager MP, Procopio MA, DeLeo JA, Arruda JL, Hildebrandt L, Howell AL. Source: Anesthesia and Analgesia. 2002 January; 94(1): 94-9, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11772808&dopt=Abstract
•
Intravenous fentanyl. Out of the operating room and gaining in popularity. Author(s): Pasero C, Montgomery R. Source: The American Journal of Nursing. 2002 April; 102(4): 73, 75, 76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11943926&dopt=Abstract
•
Intravenous methadone in the management of chronic cancer pain: safe and effective starting doses when substituting methadone for fentanyl. Author(s): Santiago-Palma J, Khojainova N, Kornick C, Fischberg DJ, Primavera LH, Payne R, Manfredi P. Source: Cancer. 2001 October 1; 92(7): 1919-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11745266&dopt=Abstract
•
Intravenous nicorandil prevents thiamylal-fentanyl-induced bronchoconstriction in humans. Author(s): Wajima Z, Yoshikawa T, Ogura A, Imanaga K, Shiga T, Inoue T, Ogawa R. Source: Critical Care Medicine. 2003 February; 31(2): 485-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576956&dopt=Abstract
•
Itraconazole-fentanyl interaction in a cancer patient. Author(s): Mercadante S, Villari P, Ferrera P. Source: Journal of Pain and Symptom Management. 2002 September; 24(3): 284-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12458106&dopt=Abstract
•
Ketamine-fentanyl-midazolam infusion for the control of symptoms in terminal life care. Author(s): Berger JM, Ryan A, Vadivelu N, Merriam P, Rever L, Harrison P. Source: Am J Hosp Palliat Care. 2000 March-April; 17(2): 127-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11406957&dopt=Abstract
Studies
49
•
Levobupivacaine for epidural analgesia in labor: the sparing effect of epidural fentanyl. Author(s): Robinson AP, Lyons GR, Wilson RC, Gorton HJ, Columb MO. Source: Anesthesia and Analgesia. 2001 February; 92(2): 410-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11159242&dopt=Abstract
•
Lidocaine with fentanyl, compared to morphine, marginally improves postoperative epidural analgesia in children. Author(s): Reinoso-Barbero F, Saavedra B, Hervilla S, de Vicente J, Tabares B, GomezCriado MS. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 January; 49(1): 67-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11782331&dopt=Abstract
•
Ligation of a patent ductus arteriosus under fentanyl anesthesia improves protein metabolism in premature neonates. Author(s): Shew SB, Keshen TH, Glass NL, Jahoor F, Jaksic T. Source: Journal of Pediatric Surgery. 2000 September; 35(9): 1277-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10999678&dopt=Abstract
•
Long-acting fentanyl analogues: synthesis and pharmacology of N-(1phenylpyrazolyl)-N-(1-phenylalkyl-4-piperidyl)propanamides. Author(s): Jagerovic N, Cano C, Elguero J, Goya P, Callado LF, Meana JJ, Giron R, Abalo R, Ruiz D, Goicoechea C, Martin MA. Source: Bioorganic & Medicinal Chemistry. 2002 March; 10(3): 817-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11814871&dopt=Abstract
•
Longitudinal follow-up of TTS-fentanyl use in patients with cancer-related pain: results of a compassionate-use study with special focus on elderly patients. Author(s): Menten J, Desmedt M, Lossignol D, Mullie A. Source: Current Medical Research and Opinion. 2002; 18(8): 488-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12564660&dopt=Abstract
•
Long-term cancer pain management in morphine pre-treated and opioid naive patients with transdermal fentanyl. Author(s): Mystakidou K, Tsilika E, Parpa E, Kouloulias V, Kouvaris I, Georgaki S, Vlahos L. Source: International Journal of Cancer. Journal International Du Cancer. 2003 November 10; 107(3): 486-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506751&dopt=Abstract
50
Fentanyl
•
Long-term management of noncancer pain with transdermal therapeutic systemfentanyl. Author(s): Mystakidou K, Parpa E, Tsilika E, Mavromati A, Smyrniotis V, Georgaki S, Vlahos L. Source: The Journal of Pain : Official Journal of the American Pain Society. 2003 August; 4(6): 298-306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14622686&dopt=Abstract
•
Long-term observations of patients receiving transdermal fentanyl after a randomized trial. Author(s): Nugent M, Davis C, Brooks D, Ahmedzai SH. Source: Journal of Pain and Symptom Management. 2001 May; 21(5): 385-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11369159&dopt=Abstract
•
Long-term safety of oral transmucosal fentanyl citrate for breakthrough cancer pain. Author(s): Payne R, Coluzzi P, Hart L, Simmonds M, Lyss A, Rauck R, Berris R, Busch MA, Nordbrook E, Loseth DB, Portenoy RK. Source: Journal of Pain and Symptom Management. 2001 July; 22(1): 575-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11516599&dopt=Abstract
•
Low dose fentanyl and propofol improve the speed and quality of tidal-breathing induction techniques in sevoflurane anesthesia for adults. Author(s): Lee Y, Huang SJ, Lin PC, Lai HY, Pan MH. Source: Acta Anaesthesiol Sin. 2001 June; 39(2): 83-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11475180&dopt=Abstract
•
Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7. 5 mg of bupivacaine. Author(s): Gupta A, Axelsson K, Thorn SE, Matthiessen P, Larsson LG, Holmstrom B, Wattwil M. Source: Acta Anaesthesiologica Scandinavica. 2003 January; 47(1): 13-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492791&dopt=Abstract
•
Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy. Author(s): Kararmaz A, Kaya S, Turhanoglu S, Ozyilmaz MA. Source: Anaesthesia. 2003 June; 58(6): 526-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846615&dopt=Abstract
•
Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery. Author(s): Ben-David B, Miller G, Gavriel R, Gurevitch A. Source: Regional Anesthesia and Pain Medicine. 2000 May-June; 25(3): 235-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10834776&dopt=Abstract
Studies
51
•
Low-dose clonidine and neostigmine prolong the duration of intrathecal bupivacainefentanyl for labor analgesia. Author(s): Owen MD, Ozsarac O, Sahin S, Uckunkaya N, Kaplan N, Magunaci I. Source: Anesthesiology. 2000 February; 92(2): 361-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10691221&dopt=Abstract
•
Lumbar epidural fentanyl: segmental spread and effect on temporal summation and muscle pain. Author(s): Eichenberger U, Giani C, Petersen-Felix S, Graven-Nielsen T, Arendt-Nielsen L, Curatolo M. Source: British Journal of Anaesthesia. 2003 April; 90(4): 467-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12644419&dopt=Abstract
•
Maximum tolerated dose of nalmefene in patients receiving epidural fentanyl and dilute bupivacaine for postoperative analgesia. Author(s): Dougherty TB, Porche VH, Thall PF. Source: Anesthesiology. 2000 April; 92(4): 1010-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10754620&dopt=Abstract
•
Minidose bupivacaine-fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Author(s): Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Source: Anesthesiology. 2000 January; 92(1): 6-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10638892&dopt=Abstract
•
Minidose lidocaine-fentanyl spinal anesthesia in ambulatory surgery: prophylactic nalbuphine versus nalbuphine plus droperidol. Author(s): Ben-David B, DeMeo PJ, Lucyk C, Solosko D. Source: Anesthesia and Analgesia. 2002 December; 95(6): 1596-600, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456423&dopt=Abstract
•
Minimum analgesic doses of fentanyl and sufentanil for epidural analgesia in the first stage of labor. Author(s): Capogna G, Camorcia M, Columb MO. Source: Anesthesia and Analgesia. 2003 April; 96(4): 1178-82, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12651680&dopt=Abstract
•
Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl. Author(s): Stocks GM, Hallworth SP, Fernando R, England AJ, Columb MO, Lyons G. Source: Anesthesiology. 2001 April; 94(4): 593-8; Discussion 5A. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11379678&dopt=Abstract
52
Fentanyl
•
Mivacurium infusion requirement and spontaneous recovery of neuromuscular transmission in children anaesthetized with nitrous oxide and fentanyl, halothane, isoflurane or sevoflurane. Author(s): Woloszczuk-Gebicka B. Source: Paediatric Anaesthesia. 2002 July; 12(6): 511-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12139592&dopt=Abstract
•
Molecular docking reveals a novel binding site model for fentanyl at the mu-opioid receptor. Author(s): Subramanian G, Paterlini MG, Portoghese PS, Ferguson DM. Source: Journal of Medicinal Chemistry. 2000 February 10; 43(3): 381-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10669565&dopt=Abstract
•
Motor block during patient-controlled epidural analgesia with ropivacaine or ropivacaine/fentanyl after intrathecal bupivacaine for caesarean section. Author(s): Buggy DJ, Hall NA, Shah J, Brown J, Williams J. Source: British Journal of Anaesthesia. 2000 September; 85(3): 468-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11103193&dopt=Abstract
•
Multiple dose pharmacokinetics of oral transmucosal fentanyl citrate in healthy volunteers. Author(s): Egan TD, Sharma A, Ashburn MA, Kievit J, Pace NL, Streisand JB. Source: Anesthesiology. 2000 March; 92(3): 665-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10719944&dopt=Abstract
•
Myoclonus secondary to withdrawal from transdermal fentanyl: case report and literature review. Author(s): Han PK, Arnold R, Bond G, Janson D, Abu-Elmagd K. Source: Journal of Pain and Symptom Management. 2002 January; 23(1): 66-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11779671&dopt=Abstract
•
Nebulized and intranasal fentanyl in the management of cancer-related breakthrough pain. Author(s): Zeppetella G. Source: Palliative Medicine. 2000 January; 14(1): 57-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10717724&dopt=Abstract
•
Nebulized fentanyl citrate improves patients' perception of breathing, respiratory rate, and oxygen saturation in dyspnea. Author(s): Coyne PJ, Viswanathan R, Smith TJ. Source: Journal of Pain and Symptom Management. 2002 February; 23(2): 157-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11844637&dopt=Abstract
Studies
53
•
Nebulized fentanyl for relief of abdominal pain. Author(s): Bartfield JM, Flint RD, McErlean M, Broderick J. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2003 March; 10(3): 215-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12615585&dopt=Abstract
•
Neonatal abstinence syndrome due to prolonged administration of fentanyl in pregnancy. Author(s): Regan J, Chambers F, Gorman W, MacSullivan R. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 April; 107(4): 570-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10759282&dopt=Abstract
•
Neonatal monitoring after maternal fentanyl analgesia in labor. Author(s): Nikkola EM, Jahnukainen TJ, Ekblad UU, Kero PO, Salonen MA. Source: Journal of Clinical Monitoring and Computing. 2000; 16(8): 597-608. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12580236&dopt=Abstract
•
Ondansetron is effective in treatment of pruritus after intrathecal fentanyl. Author(s): Henry A, Tetzlaff JE, Steckner K. Source: Regional Anesthesia and Pain Medicine. 2002 September-October; 27(5): 538-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12373716&dopt=Abstract
•
Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket. Author(s): Frolich MA, Giannotti A, Modell JH, Frolich M. Source: Anesthesia and Analgesia. 2001 September; 93(3): 647-8. Erratum In: Anesth Analg 2002 May; 94(5): 1172. Frolich M [corrected to Frolich Ma]. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11524334&dopt=Abstract
•
Opioid switching from morphine to transdermal fentanyl for toxicity reduction in palliative care. Author(s): McNamara P. Source: Palliative Medicine. 2002 September; 16(5): 425-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380661&dopt=Abstract
•
Oral premedication with fentanyl may be a safe and effective alternative to oral midazolam. Author(s): Tamura M, Nakamura K, Kitamura R, Kitagawa S, Mori N, Ueda Y. Source: European Journal of Anaesthesiology. 2003 June; 20(6): 482-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803268&dopt=Abstract
54
Fentanyl
•
Oral transmucosal fentanyl and sufentanil for incident pain. Author(s): Gardner-Nix J. Source: Journal of Pain and Symptom Management. 2001 August; 22(2): 627-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11503630&dopt=Abstract
•
Oral transmucosal fentanyl citrate as a premedicant. Author(s): Howell TK. Source: British Journal of Anaesthesia. 2000 December; 85(6): 938-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11732540&dopt=Abstract
•
Oral transmucosal fentanyl pretreatment for outpatient general anesthesia. Author(s): Moore PA, Cuddy MA, Magera JA, Caputo AC, Chen AH, Wilkinson LA. Source: Anesthesia Progress. 2000 Spring; 47(2): 29-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11881693&dopt=Abstract
•
Paralytic ileus in a mechanically ventilated preterm infant treated with fentanyl. Author(s): Pezzati M, Bertini G, Chiti G, Danesi G, Lachina L, Rubaltelli FF. Source: Pediatr Med Chir. 2001 May-August; 23(3-4): 201-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11723859&dopt=Abstract
•
Partial versus full agonists for opioid-mediated analgesia--focus on fentanyl and buprenorphine. Author(s): Zuurmond WW, Meert TF, Noorduin H. Source: Acta Anaesthesiol Belg. 2002; 53(3): 193-201. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12461829&dopt=Abstract
•
Patient anxiety scores after low-dose ketamine or fentanyl for epidural catheter placement. Author(s): Oda A, Iida H, Dohi S. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2000 September; 47(9): 910-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10989865&dopt=Abstract
•
Patient-controlled analgesia and sedation with fentanyl in phacoemulsification under topical anesthesia. Author(s): Aydin ON, Kir E, Ozkan SB, Gursoy F. Source: Journal of Cataract and Refractive Surgery. 2002 November; 28(11): 1968-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12457671&dopt=Abstract
Studies
55
•
Patient-controlled epidural analgesia in labor: the addition of clonidine to bupivacaine-fentanyl. Author(s): Paech MJ, Pavy TJ, Orlikowski CE, Evans SF. Source: Regional Anesthesia and Pain Medicine. 2000 January-February; 25(1): 34-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10660238&dopt=Abstract
•
Patient-controlled epidural analgesia with fentanyl-bupivacaine: influence of prior dural puncture. Author(s): Beaubien G, Drolet P, Girard M, Grenier Y. Source: Regional Anesthesia and Pain Medicine. 2000 May-June; 25(3): 254-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10834779&dopt=Abstract
•
Patient-controlled epidural analgesia: a prospective audit of epidural pethidine 4 mg/ml and ropivacaine 0.2% with fentanyl 2 micrograms/ml. Author(s): Tay TG, Brake TJ, Kwan AS. Source: Anaesthesia and Intensive Care. 2003 August; 31(4): 412-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12973966&dopt=Abstract
•
Patient-controlled epidural fentanyl following spinal fentanyl at Caesarean section. Author(s): Cooper DW, Garcia E, Mowbray P, Millar MA. Source: Anaesthesia. 2002 March; 57(3): 266-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11892635&dopt=Abstract
•
Patient-reported utilization patterns of fentanyl transdermal system and oxycodone hydrochloride controlled-release among patients with chronic nonmalignant pain. Author(s): Ackerman SJ, Mordin M, Reblando J, Xu X, Schein J, Vallow S, Brennan M. Source: J Manag Care Pharm. 2003 May-June; 9(3): 223-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14613465&dopt=Abstract
•
Pharmacokinetics of human cerebral opioid extraction: a comparative study on sufentanil, fentanyl, and alfentanil in a patient after severe head injury. Author(s): Metz C, Gobel L, Gruber M, Hoerauf KH, Taeger K. Source: Anesthesiology. 2000 June; 92(6): 1559-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10839904&dopt=Abstract
•
Pharmacokinetics of transdermal fentanyl in the peri-operative period in young children. Author(s): Paut O, Camboulives J, Viard L, Lemoing JP, Levron JC. Source: Anaesthesia. 2000 December; 55(12): 1202-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11121932&dopt=Abstract
56
Fentanyl
•
Pharmacokinetics of transdermal fentanyl. Author(s): Thompson JP, Rowbotham DJ. Source: Anesthesia and Analgesia. 2002 September; 95(3): 781. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12198075&dopt=Abstract
•
Plasma concentration of fentanyl with xenon to block somatic and hemodynamic responses to surgical incision. Author(s): Nakata Y, Goto T, Saito H, Ishiguro Y, Terui K, Kawakami H, Tsuruta Y, Niimi Y, Morita S. Source: Anesthesiology. 2000 April; 92(4): 1043-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10754624&dopt=Abstract
•
Population pharmacokinetics of fentanyl in healthy volunteers. Author(s): Ariano RE, Duke PC, Sitar DS. Source: Journal of Clinical Pharmacology. 2001 July; 41(7): 757-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11452708&dopt=Abstract
•
Possible overestimation of indocyanine green-derived plasma volume early after induction of anesthesia with propofol/fentanyl. Author(s): Mi WD, Ishihara H, Sakai T, Matsuki A. Source: Anesthesia and Analgesia. 2003 November; 97(5): 1421-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570660&dopt=Abstract
•
Postoperative epidural analgesia in children after major orthopaedic surgery. A randomised study of the effect on PONV of two anaesthetic techniques: low and high dose i.v. fentanyl and epidural infusions with and without fentanyl. Author(s): Lovstad RZ, Stoen R. Source: Acta Anaesthesiologica Scandinavica. 2001 April; 45(4): 482-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11300388&dopt=Abstract
•
Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases. Author(s): Lejus C, Surbled M, Schwoerer D, Renaudin M, Guillaud C, Berard L, Pinaud M. Source: Paediatric Anaesthesia. 2001 May; 11(3): 327-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11359592&dopt=Abstract
•
Postoperative pain management in patients undergoing major surgery after remifentanil vs. fentanyl anesthesia. Multicentre Investigator Group. Author(s): Minkowitz HS. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2000 June; 47(6): 522-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10875715&dopt=Abstract
Studies
57
•
Potential for duragesic patch abuse. Author(s): Purucker M, Swann W. Source: Annals of Emergency Medicine. 2000 March; 35(3): 314. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10692207&dopt=Abstract
•
Preemptive analgesia with tramadol and fentanyl in pediatric neurosurgery. Author(s): Chiaretti A, Viola L, Pietrini D, Piastra M, Savioli A, Tortorolo L, Caldarelli M, Stoppa F, Di Rocco C. Source: Child's Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery. 2000 February; 16(2): 93-9; Discussion 100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10663814&dopt=Abstract
•
Pre-emptive efficacy of epidural fentanyl in elective abdominal surgery. Author(s): Esmaoglu A, Cuha Y, Boyaci A. Source: European Journal of Anaesthesiology. 2001 January; 18(1): 59-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11270012&dopt=Abstract
•
Preoperative fentanyl infusion with pharmacokinetic simulation for anesthetic and perioperative management of an opioid-tolerant patient. Author(s): Davis JJ, Johnson KB, Egan TD, Vezina DP, Snell TE, Swenson JD. Source: Anesthesia and Analgesia. 2003 December; 97(6): 1661-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14633538&dopt=Abstract
•
Prolonged epidural infusions of ropivacaine (2 mg/mL) after colonic surgery: the impact of adding fentanyl. Author(s): Finucane BT, Ganapathy S, Carli F, Pridham JN, Ong BY, Shukla RC, Kristoffersson AH, Huizar KM, Nevin K, Ahlen KG; Canadian Ropivacaine Research Group. Source: Anesthesia and Analgesia. 2001 May; 92(5): 1276-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11323362&dopt=Abstract
•
Prophylactic ondansetron reduces the incidence of intrathecal fentanyl-induced pruritus. Author(s): Gurkan Y, Toker K. Source: Anesthesia and Analgesia. 2002 December; 95(6): 1763-6, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456454&dopt=Abstract
•
Propofol requirement for insertion of cuffed oropharyngeal airway versus laryngeal mask airway with and without fentanyl: a dose-finding study. Author(s): Tanaka M, Nishikawa T. Source: British Journal of Anaesthesia. 2003 January; 90(1): 14-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12488372&dopt=Abstract
58
Fentanyl
•
Propofol-ketamine versus propofol-fentanyl for outpatient laparoscopy: comparison of postoperative nausea, emesis, analgesia, and recovery. Author(s): Vallejo MC, Romeo RC, Davis DJ, Ramanathan S. Source: Journal of Clinical Anesthesia. 2002 September; 14(6): 426-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12393110&dopt=Abstract
•
Pulmonary-to-systemic blood flow ratio effects of sevoflurane, isoflurane, halothane, and fentanyl/midazolam with 100% oxygen in children with congenital heart disease. Author(s): Laird TH, Stayer SA, Rivenes SM, Lewin MB, McKenzie ED, Fraser CD, Andropoulos DB. Source: Anesthesia and Analgesia. 2002 November; 95(5): 1200-6, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401594&dopt=Abstract
•
Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain. Author(s): Allan L, Hays H, Jensen NH, de Waroux BL, Bolt M, Donald R, Kalso E. Source: Bmj (Clinical Research Ed.). 2001 May 12; 322(7295): 1154-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11348910&dopt=Abstract
•
Re: Economic evaluation of fentanyl. Author(s): Oster G. Source: Journal of Pain and Symptom Management. 2001 July; 22(1): 540-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11523517&dopt=Abstract
•
Re: Economic evaluation of the fentanyl transdermal system. Author(s): Dukes EM, Dhanda R. Source: Journal of Pain and Symptom Management. 2001 July; 22(1): 538-40; Author Reply 541-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11523516&dopt=Abstract
•
Re: The fentanyl transdermal patch in the dying phase. Author(s): Kirkham SR. Source: Journal of Pain and Symptom Management. 2003 July; 26(1): 589-90; Author Reply 590. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850638&dopt=Abstract
•
Recovery and neurological examination after remifentanil-desflurane or fentanyldesflurane anaesthesia for carotid artery surgery. Author(s): Wilhelm W, Schlaich N, Harrer J, Kleinschmidt S, Muller M, Larsen R. Source: British Journal of Anaesthesia. 2001 January; 86(1): 44-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11575408&dopt=Abstract
Studies
59
•
Reduction and lumping of physiologically based pharmacokinetic models: prediction of the disposition of fentanyl and pethidine in humans by successively simplified models. Author(s): Bjorkman S. Source: Journal of Pharmacokinetics and Pharmacodynamics. 2003 August; 30(4): 285307. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14650375&dopt=Abstract
•
Reduction of pain on injection of propofol: a comparison of fentanyl with remifentanil. Author(s): Basaranoglu G, Erden V, Delatioglu H. Source: Anesthesia and Analgesia. 2002 April; 94(4): 1040-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11916821&dopt=Abstract
•
Relation between fentanyl dose and predicted EC50 of propofol for laryngeal mask insertion. Author(s): Kodaka M, Okamoto Y, Handa F, Kawasaki J, Miyao H. Source: British Journal of Anaesthesia. 2004 February; 92(2): 238-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14722176&dopt=Abstract
•
Remifentanil and fentanyl during anaesthesia for major abdominal and gynaecological surgery. An open, comparative study of safety and efficacy. Author(s): Sneyd JR, Camu F, Doenicke A, Mann C, Holgersen O, Helmers JH, Appelgren L, Noronha D, Upadhyaya BK. Source: European Journal of Anaesthesiology. 2001 September; 18(9): 605-14. Erratum In: Eur J Anaesthesiol 2001 December; 18(12): 839. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11553256&dopt=Abstract
•
Remifentanil- and fentanyl-based anesthesia for intraoperative monitoring of somatosensory evoked potentials. Author(s): Samra SK, Dy EA, Welch KB, Lovely LK, Graziano GP. Source: Anesthesia and Analgesia. 2001 June; 92(6): 1510-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11375835&dopt=Abstract
•
Remifentanil, fentanyl, and cardiac surgery: a double-blinded, randomized, controlled trial of costs and outcomes. Author(s): Myles PS, Hunt JO, Fletcher H, Watts J, Bain D, Silvers A, Buckland MR. Source: Anesthesia and Analgesia. 2002 October; 95(4): 805-12, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12351249&dopt=Abstract
60
Fentanyl
•
Respiratory arrest in a parturient following intrathecal administration of fentanyl and bupivacaine as part of a combined spinal-epidural analgesia for labour. Author(s): Kuczkowski KM. Source: Anaesthesia. 2002 September; 57(9): 939-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190769&dopt=Abstract
•
Reversible delirium during opiod switching from transdermal fentanyl to methadone. Author(s): del Rosario MA, Feria M, Martin AS, Ortega JJ, del Castillo LP. Source: Journal of Pain and Symptom Management. 2001 March; 21(3): 177-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11303498&dopt=Abstract
•
Rhinorrhea by nasal fentanyl. Author(s): Ueda W. Source: Anesthesiology. 2001 September; 95(3): 812-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11575566&dopt=Abstract
•
Ropivacaine 0.075% and bupivacaine 0.075% with fentanyl 2 microg/mL are equivalent for labor epidural analgesia. Author(s): Owen MD, Thomas JA, Smith T, Harris LC, D'Angelo R. Source: Anesthesia and Analgesia. 2002 January; 94(1): 179-83, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11772824&dopt=Abstract
•
Ropivacaine 0.2% versus bupivacaine 0.1% with fentanyl: a double blind comparison for analgesia during labour. Author(s): Dresner M, Freeman J, Calow C, Quinn A, Bamber J. Source: British Journal of Anaesthesia. 2000 December; 85(6): 826-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11732513&dopt=Abstract
•
Ropivacaine 1 mg x ml(-1) does not decrease the need for epidural fentanyl after hip replacement surgery. Author(s): Kostamovaara PA, Laurila JJ, Alahuhta S, Salomaki TE. Source: Acta Anaesthesiologica Scandinavica. 2001 April; 45(4): 489-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11300389&dopt=Abstract
•
Ropivacaine 1 mg/ml, plus fentanyl 2 microg/ml for epidural analgesia during labour. Is mode of administration important? Author(s): Smedvig JP, Soreide E, Gjessing L. Source: Acta Anaesthesiologica Scandinavica. 2001 May; 45(5): 595-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11309010&dopt=Abstract
Studies
61
•
Ropivacaine and fentanyl concentrations in patient-controlled epidural analgesia during labor: a volume-range study. Author(s): Bernard JM, Le Roux D, Frouin J. Source: Anesthesia and Analgesia. 2003 December; 97(6): 1800-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14633563&dopt=Abstract
•
Ropivacane 0.1 % with or without fentanyl for epidural postoperative analgesia: a randomized, double-blind comparison. Author(s): Lee WK, Yu KL, Tang CS, Lee LS, Fang HT, Au CF. Source: Kaohsiung J Med Sci. 2003 September; 19(9): 458-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14604321&dopt=Abstract
•
Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced by iv fentanyl. Author(s): Agarwal A, Azim A, Ambesh S, Bose N, Dhiraj S, Sahu D, Singh U. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2003 March; 50(3): 297-300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12620955&dopt=Abstract
•
Sedative tolerance accompanies tolerance to the analgesic effects of fentanyl in infant rats. Author(s): Choe CH, Smith FL. Source: Pediatric Research. 2000 June; 47(6): 727-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10832729&dopt=Abstract
•
Seizure induced by a small dose of fentanyl. Author(s): Fujimoto T, Nishiyama T, Hanaoka K. Source: Journal of Anesthesia. 2003; 17(1): 55-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12908689&dopt=Abstract
•
Self-treatment with oral transmucosal fentanyl citrate to prevent emergency room visits for pain crises: patient self-reports of efficacy and utility. Author(s): Tennant F, Hermann L. Source: Journal of Pain & Palliative Care Pharmacotherapy. 2002; 16(3): 37-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14640354&dopt=Abstract
•
Serotonin syndrome: potential consequences of Meridia combined with Demerol or fentanyl. Author(s): Giese SY, Neborsky R. Source: Plastic and Reconstructive Surgery. 2001 January; 107(1): 293-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11176649&dopt=Abstract
62
Fentanyl
•
Severe respiratory depression and sedation with transdermal fentanyl: four case studies. Author(s): Regnard C, Pelham A. Source: Palliative Medicine. 2003 December; 17(8): 714-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14694924&dopt=Abstract
•
Sevoflurane provides better recovery than propofol plus fentanyl in anaesthesia for day-care surgery. Author(s): Peduto VA, Mezzetti D, Properzi M, Giorgini C. Source: European Journal of Anaesthesiology. 2000 February; 17(2): 138-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10758459&dopt=Abstract
•
Sevoflurane-fentanyl versus etomidate-fentanyl for anesthetic induction in coronary artery bypass graft surgery patients. Author(s): Cheong KF, Choy JM. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2000 August; 14(4): 421-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10972608&dopt=Abstract
•
Simultaneous assessment of drug interactions with low- and high-extraction opioids: application to parecoxib effects on the pharmacokinetics and pharmacodynamics of fentanyl and alfentanil. Author(s): Ibrahim AE, Feldman J, Karim A, Kharasch ED. Source: Anesthesiology. 2003 April; 98(4): 853-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657846&dopt=Abstract
•
Small dose bupivacaine-fentanyl spinal analgesia combined with morphine for labor. Author(s): Hess PE, Vasudevan A, Snowman C, Pratt SD. Source: Anesthesia and Analgesia. 2003 July; 97(1): 247-52, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818975&dopt=Abstract
•
Spinal 2-chloroprocaine: the effect of added fentanyl. Author(s): Vath JS, Kopacz DJ. Source: Anesthesia and Analgesia. 2004 January; 98(1): 89-94, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14693593&dopt=Abstract
•
Stress response in infants undergoing cardiac surgery: a randomized study of fentanyl bolus, fentanyl infusion, and fentanyl-midazolam infusion. Author(s): Gruber EM, Laussen PC, Casta A, Zimmerman AA, Zurakowski D, Reid R, Odegard KC, Chakravorti S, Davis PJ, McGowan FX Jr, Hickey PR, Hansen DD. Source: Anesthesia and Analgesia. 2001 April; 92(4): 882-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11273919&dopt=Abstract
Studies
63
•
Sublingual fentanyl citrate for cancer-related breakthrough pain: a pilot study. Author(s): Zeppetella G. Source: Palliative Medicine. 2001 July; 15(4): 323-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12054149&dopt=Abstract
•
Supraspinal pupillary effects of intravenous and epidural fentanyl during isoflurane anesthesia. Author(s): Larson MD, Berry PD. Source: Regional Anesthesia and Pain Medicine. 2000 January-February; 25(1): 60-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10660242&dopt=Abstract
•
The addition of hydromorphone to epidural fentanyl does not affect analgesia in early labour. Author(s): Parker RK, Connelly NR, Lucas T, Faheem U, Rizvi AS, El-Mansouri M, Thakkar N, Kamasumadram R, Dixon K, Dunn SM, Gibson C. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 JuneJuly; 49(6): 600-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12067873&dopt=Abstract
•
The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Author(s): Cravero JP, Beach M, Thyr B, Whalen K. Source: Anesthesia and Analgesia. 2003 August; 97(2): 364-7, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873918&dopt=Abstract
•
The effect of variable-dose diazepam on dreaming and emergence phenomena in 400 cases of ketamine-fentanyl anaesthesia. Author(s): Grace RF. Source: Anaesthesia. 2003 September; 58(9): 904-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911367&dopt=Abstract
•
The effectiveness of transdermal fentanyl in palliative care. Author(s): Evans R. Source: Nurs Times. 2003 October 14-20; 99(41): 24-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14603653&dopt=Abstract
•
The fentanyl tea bag. Author(s): Barrueto F Jr, Howland MA, Hoffman RS, Nelson LS. Source: Vet Hum Toxicol. 2004 February; 46(1): 30-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14748415&dopt=Abstract
64
Fentanyl
•
The in vitro effects of remifentanil and fentanyl on isolated human right atria and saphenous veins. Author(s): Duman A, Saide Sahin A, Esra Atalik K, oZtin ogun C, Basri Ulusoy H, Durgut K, oKesli S. Source: Journal of Cardiothoracic and Vascular Anesthesia. 2003 August; 17(4): 465-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12968234&dopt=Abstract
•
The influence of fentanyl vs. s-ketamine on intubating conditions during induction of anaesthesia with etomidate and rocuronium. Author(s): Ledowski T, Wulf H. Source: European Journal of Anaesthesiology. 2001 August; 18(8): 519-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11473558&dopt=Abstract
•
The interaction between fentanyl and propofol during emergence from anesthesia: monitoring with the EEG-Bispectral index. Author(s): Mi W, Sakai T, Kudo T, Kudo M, Matsuki A. Source: Journal of Clinical Anesthesia. 2003 March; 15(2): 103-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719048&dopt=Abstract
•
The minimally effective concentration of adrenaline in a low-concentration thoracic epidural analgesic infusion of bupivacaine, fentanyl and adrenaline after major surgery. A randomized, double-blind, dose-finding study. Author(s): Niemi G, Breivik H. Source: Acta Anaesthesiologica Scandinavica. 2003 April; 47(4): 439-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694144&dopt=Abstract
•
The pharmacokinetics of transdermal fentanyl delivered with and without controlled heat. Author(s): Ashburn MA, Ogden LL, Zhang J, Love G, Basta SV. Source: The Journal of Pain : Official Journal of the American Pain Society. 2003 August; 4(6): 291-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14622685&dopt=Abstract
•
The safety and efficacy of a fentanyl patient-controlled transdermal system for acute postoperative analgesia: a multicenter, placebo-controlled trial. Author(s): Chelly JE, Grass J, Houseman TW, Minkowitz H, Pue A. Source: Anesthesia and Analgesia. 2004 February; 98(2): 427-33, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14742382&dopt=Abstract
Studies
65
•
The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration. Author(s): Ginosar Y, Riley ET, Angst MS. Source: Anesthesia and Analgesia. 2003 November; 97(5): 1428-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570661&dopt=Abstract
•
The site of action of epidural fentanyl infusions in the presence of local anesthetics: a minimum local analgesic concentration infusion study in nulliparous labor. Author(s): Ginosar Y, Columb MO, Cohen SE, Mirikatani E, Tingle MS, Ratner EF, Angst MS, Riley ET. Source: Anesthesia and Analgesia. 2003 November; 97(5): 1439-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570662&dopt=Abstract
•
The site of action of epidural fentanyl: what can be learned by studying the difference between infusion and bolus administration? The importance of history, one hopes. Author(s): Mather LE, Cousins MJ. Source: Anesthesia and Analgesia. 2003 November; 97(5): 1211-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570625&dopt=Abstract
•
The use of fentanyl and alfentanil sprays for episodic pain. Author(s): Duncan A. Source: Palliative Medicine. 2002 November; 16(6): 550. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12465709&dopt=Abstract
•
The use of nebulized fentanyl for the management of dyspnea. Author(s): Coyne PJ. Source: Clinical Journal of Oncology Nursing. 2003 May-June; 7(3): 334-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12793342&dopt=Abstract
•
Transdermal fentanyl for the management of cancer pain: a survey of 1005 patients. Author(s): Radbruch L, Sabatowski R, Petzke F, Brunsch-Radbruch A, Grond S, Lehmann KA. Source: Palliative Medicine. 2001 July; 15(4): 309-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12054148&dopt=Abstract
•
Transdermal fentanyl for the treatment of back pain caused by vertebral osteoporosis. Author(s): Ringe JD, Faber H, Bock O, Valentine S, Felsenberg D, Pfeifer M, Minne HW, Schwalen S. Source: Rheumatology International. 2002 September; 22(5): 199-203. Epub 2002 July 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12215866&dopt=Abstract
66
Fentanyl
•
Transdermal fentanyl: informed prescribing is essential. Author(s): Ross JR, Quigley C. Source: European Journal of Pain (London, England). 2003; 7(5): 481-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12935801&dopt=Abstract
•
Transient aphonia and aphagia in a parturient after induction of combined spinalepidural labor analgesia with subarachnoid fentanyl and bupivacaine. Author(s): Kuczkowski KM, Goldsworthy M. Source: Acta Anaesthesiol Belg. 2003; 54(2): 165-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872435&dopt=Abstract
•
Unrecognised anaphylaxis to propofol or fentanyl. Author(s): Lewis S, Simpson P. Source: Anaesthesia. 2001 November; 56(11): 1128-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11708342&dopt=Abstract
•
Unrecognised fatal anaphylactic reaction to propofol or fentanyl. Author(s): Girgis Y. Source: Anaesthesia. 2001 October; 56(10): 1016-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11576129&dopt=Abstract
•
Unrecognised fatal anaphylactic reaction to propofol or fentanyl. Author(s): Konarzewski W, De'Ath S. Source: Anaesthesia. 2001 May; 56(5): 497-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11350360&dopt=Abstract
•
Unrecognised fatal reaction to propofol or fentanyl. Author(s): Mertes PM, Laxenaire MC. Source: Anaesthesia. 2002 August; 57(8): 821-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12180419&dopt=Abstract
•
Uptake pharmacokinetics of the Fentanyl Oralet in children scheduled for central venous access removal: implications for the timing of initiating painful procedures. Author(s): Wheeler M, Birmingham PK, Dsida RM, Wang Z, Cote CJ, Avram MJ. Source: Paediatric Anaesthesia. 2002 September; 12(7): 594-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358654&dopt=Abstract
Studies
67
•
Use of intranasal fentanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia. Author(s): Galinkin JL, Fazi LM, Cuy RM, Chiavacci RM, Kurth CD, Shah UK, Jacobs IN, Watcha MF. Source: Anesthesiology. 2000 December; 93(6): 1378-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11149429&dopt=Abstract
•
Use of TTS fentanyl as a single opioid for cancer pain relief: a safety and efficacy clinical trial in patients naive to mild or strong opioids. Author(s): Mystakidou K, Befon S, Tsilika E, Dardoufas K, Georgaki S, Vlahos L. Source: Oncology. 2002; 62(1): 9-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11810038&dopt=Abstract
•
Validation of fentanyl pharmacokinetics in patients undergoing coronary artery bypass grafting. Author(s): Hudson RJ, Thomson IR, Henderson BT, Singh K, Harding G, Peterson DJ. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 April; 49(4): 388-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11927479&dopt=Abstract
•
Which administration route of fentanyl better enhances the spread of spinal anaesthesia: intravenous, intrathecal or both? Author(s): Kararmaz A, Kaya S, Turhanoglu S, Ozyilmaz MA. Source: Acta Anaesthesiologica Scandinavica. 2003 October; 47(9): 1096-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12969102&dopt=Abstract
69
CHAPTER 2. NUTRITION AND FENTANYL Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and fentanyl.
Finding Nutrition Studies on Fentanyl The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “fentanyl” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
70
Fentanyl
The following information is typical of that found when using the “Full IBIDS Database” to search for “fentanyl” (or a synonym): •
A comparison of fentanyl and morphine use in neonates (continuing education credit). Source: Maguire, D P Maloney, P Neonatal-Netw. 1988 August; 7(1): 27-35 0730-0832
•
A comparison of transdermal fentanyl versus epidural morphine for analgesia in dogs undergoing major orthopedic surgery. Author(s): Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison 53706-1102, USA. Source: Robinson, T M Kruse Elliott, K T Markel, M D Pluhar, G E Massa, K Bjorling, D E J-Am-Anim-Hosp-Assoc. 1999 Mar-April; 35(2): 95-100 0587-2871
•
Antagonisation of fentanyl-induced respiratory depression by nalbuphine. Author(s): Department of Anesthesia and Intensive Care, B. G. Trauma Center, Frankfurt-am-Main, West Germany. Source: Latasch, L Teichmuller, T Dudziak, R Probst, S Acta-Anaesthesiol-Belg. 1989; 40(1): 35-40 0001-5164
•
Antagonism of fentanyl-induced respiratory depression with nalmefene. Author(s): University of Miami, Department of Anesthesiology. Source: Moore, L R Bikhazi, G B Tuttle, R R Weidler, D J Methods-Find-Exp-ClinPharmacol. 1990 Jan-February; 12(1): 29-35 0379-0355
•
Antagonism of the respiratory and analgesic effect of fentanyl produced by aminophylline. Source: Ho, R T Jawan, B Fung, S T Lee, J H Ma-Zui-Xue-Za-Zhi. 1989 September; 27(3): 227-33 0254-1319
•
Anticonvulsant therapy increases fentanyl requirements during anaesthesia for craniotomy. Author(s): Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110. Source: Tempelhoff, R Modica, P A Spitznagel, E L Can-J-Anaesth. 1990 April; 37(3): 327-32 0832-610X
•
Atropine-induced heart rate changes: a comparison between midazolam-fentanylpropofol-N2O and midazolam-fentanyl-thiopentone-enflurane-N2O anaesthesia. Author(s): Dept. of Anaesthesia, St. Thomas' Hospital, London, United Kingdom. Source: Cross, G Gaylard, D Lim, M Can-J-Anaesth. 1990 May; 37(4 Pt 1): 416-9 0832610X
•
Calculating the cost for drug treatment including the adverse drug reactions treatment cost (primer for fentanyl TTS in Bulgaria). Author(s): Department of Social Pharmacy, Faculty of Pharmacy, Medical University, Sofia, Bulgaria. Source: Petrova, G I Getov, I N Boll-Chim-Farm. 2002 Mar-April; 141(2): 150-3 0006-6648
•
Comparison between epidural infusion of fentanyl/bupivacaine and morphine/bupivacaine after orthopaedic surgery. Author(s): Department of Anaesthesiology and Intensive Care, University of Milan, IRCCS H. San Raffaele, Italy. Source: Berti, M Fanelli, G Casati, A Lugani, D Aldegheri, G Torri, G Can-J-Anaesth. 1998 June; 45(6): 545-50 0832-610X
Nutrition
71
•
Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery. Author(s): Department of Anesthesia, Children's Hospital Los Angeles, California 90027, USA. Source: Goodarzi, M Paediatr-Anaesth. 1999; 9(5): 419-22 1155-5645
•
Comparison of nalbuphine and fentanyl in combination with diazepam for outpatient oral surgery. Author(s): Division of Oral and Maxillofacial Surgery, Duke University Medical Center, Durham, North Carolina 27710. Source: Dolan, E A Murray, W J Immediata, A R Gleason, N J-Oral-Maxillofac-Surg. 1988 June; 46(6): 471-3 0278-2391
•
Comparison of the use of nalbuphine and fentanyl during third molar surgery. Author(s): Keesler Medical Center, Biloxi, Mississippi. Source: Canning, H B Frost, D E McDonald, D K Joyner, R W J-Oral-Maxillofac-Surg. 1988 December; 46(12): 1048-50 0278-2391
•
Constipation and the use of laxatives: a comparison between transdermal fentanyl and oral morphine. Author(s): Department of Anaesthesiology, University of Cologne, Germany.
[email protected] Source: Radbruch, L Sabatowski, R Loick, G Kulbe, C Kasper, M Grond, S Lehmann, K A Palliat-Med. 2000 March; 14(2): 111-9 0269-2163
•
Effect of fentanyl and naloxone on a thalamic induced painful response in intractable epileptic patients. Author(s): Departments of Functional Neurosurgery and Anesthesiology, General Hospital of Mexico, SS and UMR Neurophysiology, National Medical Center, IMSS, Mexico City, Mexico. Source: Velasco, M Brito, F Jimenez, F Gallegos, M Velasco, A L Velasco, F StereotactFunct-Neurosurg. 1998; 71(2): 90-102 1011-6125
•
Effects of midazolam on fentanyl antinociception and respiration in a rabbit model. Author(s): Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland. Source: Hyatt, J Coro, C Bergman, S A Wynn, R L J-Oral-Maxillofac-Surg. 1989 December; 47(12): 1298-302 0278-2391
•
Evaluation of poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) (PEOPPO-PEO) gels as a release vehicle for percutaneous fentanyl. Author(s): Department of Pharmaceutics, School of Pharmacy, Taipei Medical College, 250 Wu Hsing St., 110, Taipei, Taiwan.
[email protected] Source: Liaw, J Lin, Y J-Control-Release. 2000 August 10; 68(2): 273-82 0168-3659
•
Fentanyl and alfentanil initiate the migrating myoelectric complex but not the vomiting response in the canine small intestine. Source: Groner, J I Schumann, R Lang, I M Telford, G L Curr-Surg. 1988 May-June; 45(3): 209-11 0149-7944
•
Improved bowel function after gynecological surgery with epidural bupivacainefentanyl than bupivacaine-morphine infusion. Author(s): Magee-Womens Hospital, University of Pittsburgh School of Medicine, Department of Anesthesiology, PA 15213, USA.
[email protected] Source: Vallejo, M C Edwards, R P Shannon, K T Kaul, B Finegold, H Morrison, H L Ramanathan, S Can-J-Anaesth. 2000 May; 47(5): 406-11 0832-610X
72
Fentanyl
•
Ineffective ventilation during conscious sedation due to chest wall rigidity after intravenous midazolam and fentanyl. Author(s): University of Cincinnati College of Medicine, Ohio. Source: Ackerman, W E Phero, J C Theodore, G T Anesth-Prog. 1990 Jan-February; 37(1): 46-8 0003-3006
•
Inefficacy of high-dose transdermal fentanyl in a patient with neuropathic pain, a case report. Author(s): Pain Clinic, Department of Anaesthesiology, University Hospital Nijmegen, 6500 HB Nijmegen, the Netherlands. Source: Bleeker, C P Bremer, R C Dongelmans, D A van Dongen, R T Crul, B J Eur-JPain. 2001; 5(3): 325-9; discussion 329-31 1090-3801
•
Intraarticular fentanyl compared with morphine for pain relief following arthroscopic knee surgery. Author(s): Department of Anesthesia, Western Galilee Hospital, Nahariya, Israel. Source: Varkel, V Volpin, G Ben David, B Said, R Grimberg, B Simon, K Soudry, M CanJ-Anaesth. 1999 September; 46(9): 867-71 0832-610X
•
Patient-controlled analgesia (PCA) using fentanyl in a parturient with a platelet function abnormality. Author(s): Department of Anaesthesia, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Source: Kleiman, S J Wiesel, S Tessler, M J Can-J-Anaesth. 1991 May; 38(4 Pt 1): 489-91 0832-610X
•
Postoperative pain management in patients undergoing major surgery after remifentanil vs. fentanyl anesthesia. Multicentre Investigator Group. Author(s): Department of Anesthesiology, Memorial Hospital, Memorial City, Houston, TX 77024, USA.
[email protected] Source: Minkowitz, H S Can-J-Anaesth. 2000 June; 47(6): 522-8 0832-610X
•
Quality of life and cancer pain: satisfaction and side effects with transdermal fentanyl versus oral morphine. Author(s): University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
[email protected] Source: Payne, R Mathias, S D Pasta, D J Wanke, L A Williams, R Mahmoud, R J-ClinOncol. 1998 April; 16(4): 1588-93 0732-183X
•
Simple devices in differentiating the effects of buprenorphine and fentanyl in healthy volunteers. Source: Manner, T Kanto, J Salonen, M Eur-J-Clin-Pharmacol. 1987; 31(6): 673-6 00316970
•
Structure-activity studies of fentanyl. Author(s): School of Pharmacy and Pharmacology, University of Bath, UK. Source: Casy, A F Huckstep, M R J-Pharm-Pharmacol. 1988 September; 40(9): 605-8 00223573
•
The efficacy and safety of nalbuphine (NUBAIN) in balanced anesthesia. A double blind comparison with fentanyl in gynecological and urological surgery. Author(s): Medical Faculty University of Nijmegen, The Netherlands. Source: Crul, J F Smets, M J van Egmond, J Acta-Anaesthesiol-Belg. 1990; 41(3): 261-7 0001-5164
Nutrition
73
•
The growth hormone secretory response to fentanyl in rat: an involvement of mu type receptors. Author(s): Laboratory of Pharmacology, Faculty of Medicine and Pharmacy, Free University of Brussels (V.U.B.), Belgium. Source: Govaerts, J Buydens, P Finne, E Matton, A Vanhaelst, L J-Endocrinol-Invest. 1990 December; 13(11): 911-5 0391-4097
•
The inhibitory effect of fentanyl, nicomorphine and 6-nicotinoyl morphine on phrenic nerve activity in relation to their cardiovascular effects in the anaesthetized cat. Source: Porsius, A J Borgdorff, P van Rooij, H H de Neef, J H Arch-Int-PharmacodynTher. 1987 March; 286(1): 123-35 0003-9780
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
•
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
•
The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
•
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
•
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
•
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
•
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
•
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
•
Google: http://directory.google.com/Top/Health/Nutrition/
74
Fentanyl
•
Healthnotes: http://www.healthnotes.com/
•
Open Directory Project: http://dmoz.org/Health/Nutrition/
•
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
•
WebMD®Health: http://my.webmd.com/nutrition
•
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
The following is a specific Web list relating to fentanyl; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
Minerals Magnesium Source: Healthnotes, Inc.; www.healthnotes.com
75
CHAPTER 3. ALTERNATIVE MEDICINE AND FENTANYL Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to fentanyl. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to fentanyl and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “fentanyl” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to fentanyl: •
“Silent” regurgitation and aspiration during general anesthesia. Author(s): Blitt CD, Gutman HL, Cohen DD, Weisman H, Dillon JB. Source: Anesthesia and Analgesia. 1970 September-October; 49(5): 707-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5534428&dopt=Abstract
•
Acupuncture and transcutaneous stimulation analgesia in comparison with moderatedose fentanyl anaesthesia in major surgery. Clinical efficacy and influence on recovery and morbidity. Author(s): Kho HG, Eijk RJ, Kapteijns WM, van Egmond J. Source: Anaesthesia. 1991 February; 46(2): 129-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1908190&dopt=Abstract
•
Biasing effect of the electromyogram on BIS: a controlled study during high-dose fentanyl induction. Author(s): Renna M, Wigmore T, Mofeez A, Gillbe C.
76
Fentanyl
Source: Journal of Clinical Monitoring and Computing. 2002 August; 17(6): 377-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885182&dopt=Abstract •
Comparison of fentanyl and halothane as supplement to nitrous-oxide-oxygen anaesthesia for coronary artery surgery. Author(s): Fischerstrom A, Ohqvist G, Settergren G. Source: Acta Anaesthesiologica Scandinavica. 1985 January; 29(1): 16-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3872000&dopt=Abstract
•
Effect of current density on pharmacokinetics following continuous or intermittent input from a fentanyl electrotransport system. Author(s): Gupta SK, Southam M, Sathyan G, Klausner M. Source: Journal of Pharmaceutical Sciences. 1998 August; 87(8): 976-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9687342&dopt=Abstract
•
Effect of high-dose fentanyl on renal function in dogs. Author(s): Castiglia YM, Braz JR, Vianna PT, Lemonica L, Vane LA. Source: Rev Paul Med. 1997 May-June; 115(3): 1433-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9532845&dopt=Abstract
•
Effects of agmatine on the escalation of intravenous cocaine and fentanyl selfadministration in rats. Author(s): Morgan AD, Campbell UC, Fons RD, Carroll ME. Source: Pharmacology, Biochemistry, and Behavior. 2002 July; 72(4): 873-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12062577&dopt=Abstract
•
Effects of anesthesia based on large versus small doses of fentanyl on natural killer cell cytotoxicity in the perioperative period. Author(s): Beilin B, Shavit Y, Hart J, Mordashov B, Cohn S, Notti I, Bessler H. Source: Anesthesia and Analgesia. 1996 March; 82(3): 492-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8623949&dopt=Abstract
•
Effects on the bispectral index during medium-high dose fentanyl induction with or without propofol supplement. Author(s): Barr G, Anderson RE, Owall A, Jakobsson JG. Source: Acta Anaesthesiologica Scandinavica. 2000 August; 44(7): 807-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10939694&dopt=Abstract
•
E-TRANS fentanyl. ALZA. Author(s): Mystakidou K.
Alternative Medicine 77
Source: Curr Opin Investig Drugs. 2002 March; 3(3): 463-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12054098&dopt=Abstract •
Event-related potential correlates of analgesia; comparison of fentanyl, acupuncture, and nitrous oxide. Author(s): Chapman CR, Colpitts YM, Benedetti C, Butler S. Source: Pain. 1982; 14(4): 327-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7162837&dopt=Abstract
•
Fentanyl and midazolam anaesthesia for coronary bypass surgery: a clinical study of bispectral electroencephalogram analysis, drug concentrations and recall. Author(s): Barr G, Anderson RE, Samuelsson S, Owall A, Jakobsson JG. Source: British Journal of Anaesthesia. 2000 June; 84(6): 749-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10895750&dopt=Abstract
•
Haemodynamic and plasma vasopressin responses with high-dose fentanyl anaesthesia during aorto-coronary bypass operations. Author(s): Crone LA, Wilson N, Ngsee J, Turnbull KW, Leighton K. Source: Can Anaesth Soc J. 1982 November; 29(6): 525-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6128067&dopt=Abstract
•
Hypnoanalgesia with R 8110/fentanyl in the dog: pharmacodynamic and pharmacokinetic interactions. Author(s): Monbaliu J, Degryse AD, Ooms LA, Van Dijk P, Lagerweij E, Michiels M, Woestenborghs R, Heykants J. Source: Journal of Veterinary Pharmacology and Therapeutics. 1988 March; 11(1): 63-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3379665&dopt=Abstract
•
Muscle relaxants change myocardial metabolism in patients with ischemic heart disease during high-dose fentanyl anesthesia. Author(s): Gilbert M, Anderson EA, Brondbo A, Bjertnaes LJ. Source: Acta Anaesthesiologica Scandinavica. 1990 January; 34(1): 47-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2309542&dopt=Abstract
•
Potentiated hypnotic action with a combination of fentanyl, a calcium channel blocker and an alpha 2-agonist in rats. Author(s): Horvath G, Szikszay M, Benedek G. Source: Acta Anaesthesiologica Scandinavica. 1992 February; 36(2): 170-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1347964&dopt=Abstract
•
Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. Author(s): Anand KJ, Sippell WG, Aynsley-Green A.
78
Fentanyl
Source: Lancet. 1987 January 10; 1(8524): 62-6. Erratum In: Lancet 1987 Jan 24; 1(8526): 234. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2879174&dopt=Abstract •
Sensory changes and pain after abdominal hysterectomy: a comparison of anesthetic supplementation with fentanyl versus magnesium or ketamine. Author(s): Wilder-Smith OH, Arendt-Nielsen L, Gaumann D, Tassonyi E, Rifat KR. Source: Anesthesia and Analgesia. 1998 January; 86(1): 95-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9428859&dopt=Abstract
•
Slow EEG-power spectra correlate with haemodynamic changes during laryngoscopy and intubation following induction with fentanyl or sufentanil. Author(s): Freye E, Dehnen-Seipel H, Latasch L, Behler M, Wilder-Smith OH. Source: Acta Anaesthesiol Belg. 1999; 50(2): 71-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10418645&dopt=Abstract
•
The effects of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl. Author(s): Liu SS, Gerancher JC, Bainton BG, Kopacz DJ, Carpenter RL. Source: Anesthesia and Analgesia. 1996 January; 82(1): 98-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8712434&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
•
AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
•
Chinese Medicine: http://www.newcenturynutrition.com/
•
drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html
•
Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
•
Google: http://directory.google.com/Top/Health/Alternative/
•
Healthnotes: http://www.healthnotes.com/
•
MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
•
Open Directory Project: http://dmoz.org/Health/Alternative/
•
HealthGate: http://www.tnp.com/
•
WebMD®Health: http://my.webmd.com/drugs_and_herbs
•
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
Alternative Medicine 79
•
Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to fentanyl; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
Herbs and Supplements Fentanyl Source: Healthnotes, Inc.; www.healthnotes.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
81
CHAPTER 4. CLINICAL TRIALS AND FENTANYL Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning fentanyl.
Recent Trials on Fentanyl The following is a list of recent trials dedicated to fentanyl.8 Further information on a trial is available at the Web site indicated. •
Randomized Study of Propofol versus Fentanyl and Midazolam in Pediatric Patients Requiring Mechanical Ventilation and Sedation Therapy Condition(s): Respiration Disorders Study Status: This study is completed. Sponsor(s): FDA Office of Orphan Products Development; Case Western Reserve University Purpose - Excerpt: Objectives: I. Assess the degree of amnesia afforded by study sedatives relative to the patient's intensive care unit experiences. II. Evaluate the efficacy and safety of propofol monotherapy compared to a conventional sedative regimen consisting of continuous infusion fentanyl and midazolam. III. Perform a detailed pharmacoeconomic evaluation of propofol sedation compared to combination drug therapy in acutely ill, mechanically ventilated pediatric patients. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004424
8
These are listed at www.ClinicalTrials.gov.
82
Fentanyl
Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “fentanyl” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
•
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
•
For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
•
For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm
•
For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
•
For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm
•
For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp
•
For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm
•
For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
•
For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm
•
For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm
•
For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
•
For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm
Clinical Trials 83
•
For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm
•
For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials
85
CHAPTER 5. PATENTS ON FENTANYL Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “fentanyl” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on fentanyl, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Fentanyl By performing a patent search focusing on fentanyl, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We
9Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
86
Fentanyl
will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on fentanyl: •
Abusable substance dosage form having reduced abuse potential Inventor(s): Goetz; Victor (Philadelphia, PA), Lee; Eun S. (Redwood City, CA) Assignee(s): Alza Corporation (palo Alto, Ca) Patent Number: 5,236,714 Date filed: November 1, 1988 Abstract: Compositions and dosage forms for administering abusable substances are disclosed which have a reduced potential for abuse without diminishing the therapeutic or beneficial effects of the abusable substance. Topical compositions for application to the skin or mucosa contain the abusable substance in a form which is permeable to the skin or mucosa to which it is to be applied and an antagonist for the abusable substance is present in the composition in an abuse negating amount and in a form that is impermeable to the skin or mucosa to which the composition is to be applied. Controlled release dosage forms which release the abusable substance from a drug reservoir composition confined behind a release rate controlling barrier have the abusable substance and its antagonist in the drug reservoir. The abusable substance is present in a form that is releasable from the dosage form and the antagonist is present in an abuse negating amount in a form that is not releasable from the dosage form. Thus the compositions and dosage forms of this invention permit the therapeutic use, at substantially full potency, of an abusable substance when use as prescribed but reduce the abuse potential of the compositions and dosage forms by other routes of administration. Preferred embodiments of the invention utilize fentanyl as the abusable substance and naltrexone as the antagonist in a transdermal dosage form. Excerpt(s): This invention relates to dosage forms of abusable substances having reduced potential for abuse. In particular, the dosage forms of this invention are intended to administer the abusable substance to the body by topical application to the skin or mucosa or to release the abusable substance to the body through a membrane on the dosage form. The potential for abuse by either oral or parenteral routes of narcotic and other psychoactive drugs is well known. For example, the potential for abuse of the synthetic narcotic drug fentanyl is so high that it has become a major cause of death for anesthesiologists and other hospital workers having access to the drug. In order to prevent abuse of these substances, it has been proposed to provide dosage forms which combine the abusable substance with an amount of an antagonist for the abusable substance sufficient to eliminate the "high" associated with abuse of the substance without eliminating the other therapeutic benefits for which the drugs are intended to be administered. See, for example, U.S. Pat. Nos. 4,457,933, 3,493,657 and 3,773,955 which are incorporated herein by reference. Many abusable substances are capable of being administered to the body by direct application of the drug to the skin or mucosa, i.e., nasal, vaginal, oral, or rectal mucosa. They can also be delivered to the body from advanced dosage forms such as those described in U.S. Pat. Nos. 4,655,766, 4,588,580, 3,993,073, and 3,845,770 which are incorporated herein by reference. Compositions suitable for topical application to the skin or for forming reservoir compositions in the advanced dosage forms described above could be subject to abuse, and it would clearly be desirable to have such compositions or dosage forms available in a condition in which the abuse potential of the composition or dosage form is reduced without diminishing the therapeutic efficacy of the abusable substance to be administered.
Patents 87
Web site: http://www.delphion.com/details?pn=US05236714__ •
Devices and methods for pain management Inventor(s): Johnson; Randolph Mellus (Half Moon Bay, CA), Theeuwes; Felix (Los Altos Hills, CA) Assignee(s): Durect Corporation (cupertino, Ca) Patent Number: 6,541,021 Date filed: March 10, 2000 Abstract: The invention features devices and methods for the systemic delivery of fentanyl or a fentanyl congener (e.g., sufentanil) to treat pain. In the present invention, a drug formulation comprising fentanyl or a fentanyl congener is stored within a drug delivery device (e.g., contained in a reservoir or impregnated within a matrix within the controlled drug delivery device). The drug formulation comprises an amount of drug sufficient for treatment and is stable at body temperatures (i.e., no unacceptable degradation) for the entire pre-selected treatment period. The drug delivery devices store the drug formulation safely (e.g., without dose dumping), provide sufficient protection from bodily processes to prevent unacceptable degradation of the formulation, and release the drug formulation in a controlled fashion at a therapeutically effective rate to treat pain. In use, the drug delivery device is implanted in the subject's body at an implantation site, and the drug formulation is released from the drug delivery device to a delivery site. The delivery site may be the same as, near, or distant from the implantation site. Once released at the delivery site, the drug formulation enters the systemic circulation and is transported to the site of action in the body to modulate the pain response (e.g., the brain or other pain sensory location). Excerpt(s): The invention relates to devices and methods for the management of pain. Many medications are used for the treatment of pain, ranging from well known, overthe-counter compounds such as aspirin, acetominophen, ibuprofen and other nonsteroidal anti-inflammatory compounds to the newly developed chemical entities such as the cyclooxygenase. II inhibitor compounds. Opiates in various forms, including opium, heroine and morphine which derive from the opium poppy, have very powerful analgesic properties. Opiates have been widely used for anesthesia as well for the treatment of pain, especially where the pain is very severe. In addition to these natural opiates, many synthetic opioids have since been synthesized including methadone, fentanyl and congeners of fentanyl such as sufentanil, alfentanil, lofentanil, carfentanil, remifentanil, etc. Of the opioids, morphine is still the drug of choice for management of pain at least in part due to its low cost, the ability of the drug to provide relief from pain of a variety of origins, and the vast experience with this drug. Despite its therapeutic advantages and vast experience with the drug, many pain management experts believe that morphine and other opioids are under-prescribed for patients who require longterm pain therapy. One reason for underprescription is the risk of the side effects associated with long-term administration of opioids in general, such as development of opiate tolerance, dependence, constipation, and/or other undesirable side effects (see, e.g., Moulin et al. 1992 Can Med. Assoc. J. 146:891-7). Patients who develop opioid tolerance require increased doses to achieve a satisfactory analgesic effect, and risk the development of further undesirable side effects such as respiratory depression, which can be life threatening. Physical dependence, which is related to factors such as the dose administered and the length of the administration period, can generally only be resolved by discontinuing opioid administration, which in turn results in the onset of
88
Fentanyl
severely painful withdrawal symptoms. Other side effects that can be associated with administration of opioids include reduced cough reflex, bronchial spasms, nausea, vomiting, peripheral vasodilation, orthostatic hypotension, vagal impact on the heart, contraction of smooth muscles (sphincters), reduced peristaltic motility in the gastrointestinal tract (e.g., constipation), urinary retention, changes in regulation of body temperature and sleep pattern, and release of histamine, adrenalin, and antidiuretic hormone. The negative effects on respiratory function especially impact postoperative patients, who are particularly susceptible to depression of respiratory function. Even where the concerns regarding side effects might be outweighed by the serious need for pain relief as in terminally ill patients, many doctors still avoid prescribing opioids due to concerns of abuse of surplus medication by others in contact with the patient, or even that their frequent prescription of the drug might lead to criminal investigation. Web site: http://www.delphion.com/details?pn=US06541021__ •
Laminated composite for transdermal administration of fentanyl Inventor(s): Cleary; Gary W. (San Mateo, CA), Roy; Samir D. (Redwood City, CA) Assignee(s): Cygnus Therapeutic Systems (redwood City, Ca) Patent Number: 5,186,939 Date filed: January 15, 1992 Abstract: A laminated composite for administering fentanyl transdermally that consists of a fentanyl-impermeable occlusive backing layer and an adhesive fentanyl reservoir layer comprising fentanyl dissolved in an amine-resistant polydimethylsiloxane that has a high diffusivity and poor solubility for fentanyl which enables the fentanyl to be released rapidly from the composite over a one day period with little residual fentanyl left in the reservoir thereafter. Excerpt(s): This invention is in the field of devices for administering fentanyl transdermally for the relief of postoperative and chronic cancer pain. More particularly it relates to a laminated composite for administering fentanyl transdermally for approximately one day after which time a substantial amount of the fentanyl in the device has been depleted therefrom. Fentanyl, a synthetic opiate with a potency of 50 to 100 times that of morphine, is used clinically for the relief of pain in postsurgical patients as well as in terminal cancer patients. Pharmacodynamic studies after intramuscular administration of fentanyl have indicated that the peak analgesic effects generally occur at 1 hour after intravenous administration and are sustained for a shorter duration than morphine. The mean effective analgetic plasma concentrations of fentanyl are about 1 and 3 ng/ml for postoperative and intraoperative administration, respectively, although there is considerable intersubject variation. Up to 10 ng/ml plasma concentration of fentanyl yields similar analgetic effects in terminal cancer pain. The development of tolerance and physical dependence with repeated use of fentanyl is similar to that of other opioid drugs. However, lower initial dose may reduce the tolerance level of fentanyl. The decline over time in fentanyl plasma concentration after intravenous administration appears to be triexponential with initial distribution phase followed by two elimination phases. The volume of distribution ranged from 4.4 to 59.7 liters, the terminal elimination half-life ranged from 141 to 853 minutes while total body clearance values ranged from 160 to 1530 ml/minute. The plasma protein binding in humans is reported to be 85%. Fentanyl is cleared primarily by metabolic routes in
Patents 89
healthy volunteers and surgical patients, with renal clearance of fentanyl accounting for only 6% of the dose in volunteers. Web site: http://www.delphion.com/details?pn=US05186939__ •
Method and device for transdermal electrotransport delivery of fentanyl and sufentanil Inventor(s): Bernstein; Keith J. (Somerville, NJ), Noorduin; Henk (Bergen op Zoom, NL), Southam; Mary (Portola Valley, CA) Assignee(s): Alza Corporation (mountain View, Ca) Patent Number: 6,171,294 Date filed: July 10, 1997 Abstract: The invention provides an improved electrotransport drug delivery system for analgesic drugs, namely fentanyl and sufentanil. The fentanyl/sufentanil is provided as a water soluble salt (eg, fentanyl hydrochloride) dispersed in a hydrogel formulation for use in an electrotransport device (10). In accordance with one aspect of the invention, the concentration of fentanyl/sufentanil in the donor reservoir (26) solution is above a predetermined minimum concentration, whereby the transdermal electrotransport flux of fentanyl/sufentanil is maintained independent of the concentration of fentanyl/sufentanil in solution. In accordance with a second aspect of the present invention, the donor reservoir (26) of the electrotransport delivery device (10) is comprised of silver and the donor reservoir (26) contains a predetermined "excess" loading of fentanyl/sufentanil halide to prevent silver ion migration with attendant skin discoloration. In accordance with a third aspect of the present invention, a transdermal electrotransport delivered dose of fentanyl/sufentanil is provided which is sufficient to induce analgesia in (eg, adult) human patients suffering from moderate-to-severe pain associated with major surgical procedures. Excerpt(s): The invention relates generally to improved electrotransport drug delivery. Specifically, the invention relates to a device, composition and method for improved electrotransport delivery of analgesic drugs, particularly fentanyl and analogs of fentanyl. A composition is provided in the form of a hydrogel formulation for use in an electrotransport device. The transdermal delivery of drugs, by diffusion through the epidermis, offers improvements over more traditional delivery methods, such as subcutaneous injections and oral delivery. Transdermal drug delivery avoids the hepatic first pass effect encountered with oral drug delivery. Transdermal drug delivery also eliminates patient discomfort associated with subcutaneous injections. In addition, transdermal delivery can provide more uniform concentrations of drug in the bloodstream of the patient over time due to the extended controlled delivery profiles of certain types of transdermal delivery devices. The term "transdermal" delivery, broadly encompasses the delivery of an agent through a body surface, such as the skin, mucosa, or nails of an animal. The skin functions as the primary barrier to the transdermal penetration of materials into the body and represents the body's major resistance to the transdermal delivery of therapeutic agents such as drugs. To date, efforts have been focussed on reducing the physical resistance or enhancing the permeability of the skin for the delivery of drugs by passive diffusion. Various methods for increasing the rate of transdermal drug flux have been attempted, most notably using chemical flux enhancers. Web site: http://www.delphion.com/details?pn=US06171294__
90
•
Fentanyl
Method of fentanly administration for postoperative pain relief Inventor(s): Levy; Gerhard (Williamsville, NY), Powers Cramer; Marilou S. (Redwood, CA), Southam; Mary (Portola Valley, CA) Assignee(s): Alza Corporation (palo Alto, Ca) Patent Number: 4,822,802 Date filed: February 24, 1987 Abstract: A method of postoperative pain relief using transdermal delivery of fentanyl or its analgetically effective derivatives preceded by a dose of said material to increase the serum drug levels to steady state more quickly. Excerpt(s): This invention relates to the administration of analgesics. More particularly, this invention relates to the administration of fentanyl and its analgetically effective derivatives for analgetic purposes. Still more particularly, but without limitation thereto, this invention relates to the transdermal administration of such materials supplemented with a bolus dosage thereof. Fentanyl and its analgetically effective derivatives such as sufentanil, carfentanil, lofentanil and affentanil are classified in the art as being extremely potent narcotic analgesics and are used extensively as anesthetics. Fentanyl is described in U.S. Pat. No. 3,164,600 and its use as approved by the FDA in the United States is described in the 1984 Physician's Desk Reference, pages 1027 through 1029 with reference to the drug SUBLIMAZE.RTM. manufactured by McNeil Lab for Janssen Pharmaceutica, Inc. In use, fentanyl is commonly administered as the citrate, either as a bolus injection or infusion or a continuous infusion for the purposes of producing anesthesia. More recently, transdermal delivery of fentanyl and its analgetically effective derivatives has been accomplished and one such transdermal delivery system is disclosed in U.S. Pat. No. 4,588,580, which is incorporated herein by reference. The advantages of transdermal delivery is the ability to continuously deliver the drug at analgetically effective rates over an extended period of time. This system has proven to be successful, as reported by P.M. Plezia, J. Linford, T.H. Kramer, R.P. Iacono, and S.R. Hameroff, in Transdermal Therapeutic System (Fentanyl) for Postoperative Pain: An Efficacy, Toxicity, and Pharmacokinetic Trial, ASA Abstracts, A210, Anesthesiology, vol. 65(3A), (September, 1986). Web site: http://www.delphion.com/details?pn=US04822802__
•
Method of intrapulmonary administration of a narcotic drug Inventor(s): Farr; Stephan J. (Cardiff, GB), Rowe; Antony M. (Cardiff, GB), Rubsamen; Reid (Hayward, CA) Assignee(s): Aradigm Corporation (hayward, Ca) Patent Number: 5,910,301 Date filed: March 7, 1997 Abstract: An aerosol formulation of an aerosol propellant and a base form of a narcotic drug selected from the group consisting of fentanyl, sufentanil and remfentanyl is provided. Such a formulation allows for the drug to be dissolved within the propellant and used within a device which does not require the use of a lubricant. Formulations are also disclosed which include lubricants, wherein the lubricant and propellant are both either polar or both non-polar. Thus, the lubricant component does not act as a solvent or cosolvent, but rather acts as a lubricant for the valve used for dispersing the
Patents 91
formulation to a patient. Typical non-polar propellants include chlorofluorocarbons, which are typically used in connection with non-polar lubricants such as saturated vegetable oils, e.g. fractionated coconut oils. Typical polar propellants include hydrofluoroalkanes, which are typically used in connection with polar lubricants such as polyethylene glycols. Excerpt(s): This invention relates generally to narcotic formulations useful in pain management. More specifically, this invention relates to formulation of a narcotic in a low boiling point propellant useful for the intrapulmonary delivery of narcotics to a human patient. Narcotic therapy forms the mainstay of pain management. Narcotics can be administered in many forms to patients with postsurgical and other forms of acute and chronic pain. Morphine, one of the oldest narcotics, is available for administration in tablet or in injectable form. Fentanyl, a synthetic narcotic, was first synthesized in 1960 by Paul Janssen and found to be 150 times more potent than morphine ›Theodore Stanley, "The History and Development of the Fentanyl Series," Journal of Pain and Symptom Management (1992) 7:3 (suppl.), S3-S7!. Fentanyl and its relatives Sufentanil and Alfentanil are available for delivery by injection. In addition, fentanyl is available for administration by a transdermal delivery system in the form of a skin patch ›Duragesic.TM. (fentanyl transdermal system) package insert, Janssen Pharmaceutica, Piscataway, N.J. 08855, January-June 1991!. A feature of the synthetic narcotic fentanyl is that it has a more rapid time to onset and a shorter duration of action than morphine. This makes fentanyl a useful drug for the management of acute pain. Currently, fentanyl is typically given by intravenous injection for acute pain management. Although fentanyl can be given by a transdermal patch, transdermal delivery of fentanyl is designed for long-term administration of the drug and does not lend itself to achieving a peak level rapidly for a short-term effect. Web site: http://www.delphion.com/details?pn=US05910301__ •
Methods and apparatus for improved administration of fentanyl and sufentanil Inventor(s): Zhang; Hao (Salt Lake City, UT), Zhang; Jie (Salt Lake City, UT) Assignee(s): Zars, Inc. (salt Lake City, Ut) Patent Number: 6,284,266 Date filed: September 29, 1998 Abstract: Methods and apparatus for improving administration of analgesics through the use of heat. The present invention relates to the use of heat in conjunction with specially designed transdermal analgesic delivery systems and conventional commercial transdermal analgesic delivery systems to alter, mainly increase, the analgesic release rate from the transdermal analgesic delivery systems or the depot sites to accommodate certain clinical needs. Excerpt(s): The present invention relates to methods and apparatus for administration of fentanyl and sufentanil. More particularly, the present invention relates to using controlled heat to improve administration of fentanyl and sufentanil. The dermal administration of pharmaceutically active compounds involves the direct application of a pharmaceutically active formulation(s) to the skin, wherein the skin absorbs a portion of the pharmaceutically active compound which is then taken up by the blood stream. Such administration has long been known in the practice of medicine and continues to be an important technique in the delivery of pharmaceutically active compounds. For example, U.S. Pat. No. 4,286,592 issued Sep. 1, 1981 to Chandrasekaran shows a bandage
92
Fentanyl
for administering drugs to a user's skin consisting of an impermeable backing layer, a drug reservoir layer composed of a drug and a carrier, and a contact adhesive layer by which the bandage is affixed to the skin. Such dermal administration offers many important advantages over other delivery techniques, such as injection, oral tablets and capsules. These advantages include being noninvasive (thus, less risk of infection), avoiding first pass metabolism (metabolism of the drug in the liver when the drug is taken orally and absorbed through the gastrointestinal tract), and avoiding of high peaks and low valleys of concentration of pharmaceutically active compounds in a patient's bloodstream. In particular, high peaks and low valleys of concentration are typical in injection and oral administrations and are often associated with undesirable side effects and/or less than satisfactory intended effects. Web site: http://www.delphion.com/details?pn=US06284266__ •
Stable fentanyl composition Inventor(s): Kenyhercz; Thomas M. (Hillsborough, NJ) Assignee(s): Janssen Pharmaceutica Inc. (piscataway, Nj) Patent Number: 4,486,423 Date filed: April 21, 1983 Abstract: Low pH formulations of fentanyl and related compounds have greatly improved stability and may be used in pre-filled syringes in contact with a rubber stopper. Excerpt(s): This invention relates to stable compositions of acidic fentanyl-like drugs and particularly to compositions of fentanyl citrate which are suitable for use in pre-filled syringes. Fentanyl is the generic name for the compound N-(1-phenethyl-4 piperidyl) propionanilide, a useful injectable analgesic and anesthetic disclosed in U.S. Pat. No. 3,164,600, which is incorporated herein by reference. It has been sold for many years in the United States and elsewhere as the citrate salt under the tradename SUBLIMAZE. Fentanyl has also been sold for many years in the United States and elsewhere in combination with a material whose generic name is droperidol, this combination being sold under the tradename INNOVAR. Other acidic fentanyl-like compounds include alfentanil, lofentanil, carfentanil, and sufentanil. Other acidic injectable compounds are etomidate and lorcainide. These compounds and others are disclosed in U.S. Pat. Nos. 4,167,574; 3,998,834; 3,354,173; and 4,126,089. Web site: http://www.delphion.com/details?pn=US04486423__
•
Tape formulation for percutaneous administration containing fentanyi Inventor(s): Chono; Hideharu (Tsukuba, JP), Higo; Naruhito (Tsukuba, JP), Suzuki; Tatsuaki (Tsukuba, JP), Terahara; Takaaki (Tsukuba, JP) Assignee(s): Hisamitsu Pharmaceutical Co., Inc. (saga, Jp) Patent Number: 6,139,866 Date filed: January 13, 1998 Abstract: A tape formulation for percutaneous administration containing fentanyl which comprises fentanyl or a salt thereof, a pressure sensitive adhesive and sodium acetate, is disclosed. The salt of fentanyl is preferably fentanyl citrate. The tape
Patents 93
formulation of the present invention is little irritation to the skin and excellent in the percutaneous permeation of fentanyl and has a high stability even after the passage of time. Excerpt(s): The present invention relates to a tape formulation for percutaneous administration containing fentanyl (chemical name: 1-phenethyl-4-N-proplonyl-anilinopiperidine) or a salt thereof, which is very excellent in transdermal permeable property and which has a low irritative property to skins. The tape formulation for percutaneous administration containing fentanyl of the present invention is greatly expected to be utilized as a prolonged-action anesthetic and analgesic. Fentanyl, in particular fentanyl citrate is known as a pharmaceutical having a high analgesic effect. However, there was no useful administration method of the pharmaceutical for relatively long lasting pains such as carcinomatous pains, since its elimination half life is short and thus its effects does not last though it is utilized for the constant rate instillation before and after operation. In the USA, a prolonged-action patch formulation containing fentanyl base (trade name: DURAGESIC) is put on the market. However, it has the disadvantage of being highly irritative to administered regions (The PII value showing a primary irritant index to rabbit skins of the patch formulation is 2.2, which is a very high value compared with that of the formulation of the present invention which is 0.3 to 0.8 (see Table 3). Web site: http://www.delphion.com/details?pn=US06139866__ •
Transdermal administration of fentanyl and device therefor Inventor(s): Gale; Robert M. (Los Altos, CA), Goetz; Victor (Palo Alto, CA), Lee; Eun S. (Redwood City, CA), Taskovich; Lina T. (Palo Alto, CA), Yum; Su I. (Los Altos, CA) Assignee(s): Alza Corporation (palo Alto, Ca) Patent Number: 4,588,580 Date filed: July 23, 1984 Abstract: Transdermal delivery systems for delivery of fentanyl and its analgetically effective derivatives for extended periods of time are disclosed which deliver the base form of the drug at a rate of from 0.5 to 10.mu.g/cm.sup.2 /hr for a substantial portion of their useful life. The systems can be from 5-100 cm.sup.2 in releasing surface and preferably employ an in-line amine resistant adhesive. Preferred rate controlled systems utilize an aqueous ethanolic gel to minimize drug content. Excerpt(s): This invention relates to the administration of fentanyl for analgetic purposes and more particularly to a method and device for administering fentanyl to a subject through intact skin over an extended period of time at a substantially constant rate. Fentanyl and its analgetically effective derivatives (hereafter referred to as "derivatives") such as sufentanyl, carfentanyl, lofentanyl and alfentanyl have long been known as extremely potent and effective anesthetics and analgesics. Fentanyl is described in U.S. Pat. No. 3,164,600 and its use as approved by the FDA in the United States is described in the 1984 Physician's Desk Reference, pages 1027 through 1029 with reference to the drug SUBLIMAZE.RTM. manufactured by McNeil Lab for Janssen Pharmaceutica, Inc. In use, fentanyl is normally administered as the citrate either as a bolus injection or infusion or a continuous infusion for the purposes of producing anesthesia or analgesia. The application of transdermal drug delivery technology to the administration of a wide variety of drugs has been proposed and various systems for accomplishing this are disclosed in numerous technical journals and patents. U.S. Pat.
94
Fentanyl
Nos. 3,598,122, 4,144,317, 4,201,211, 4,262,003, and 4,379,454, all of which are incorporated herein by reference, are representative of various transdermal drug delivery systems of the prior art, which systems have the ability of delivering controlled amounts of drugs to patients for extended periods of time ranging in duration from several hours to several days. None of the above patents nor any other prior art of which the inventors are aware describes a transdermal delivery system which is intended to deliver fentanyl or its derivatives nor are they aware of data on skin permeability or therapeutic transdermal delivery rates adequate to design such a system. Furthermore, fentanyl and its derivatives have certain unique characteristics which impose a combination of restraints on a transdermal delivery system which have hitherto not been addressed in other systems. Web site: http://www.delphion.com/details?pn=US04588580__
Patent Applications on Fentanyl As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to fentanyl: •
Composition for the transdermal delivery of fentanyl Inventor(s): Cantor, Adam S.; (St. Paul, MN), Ocheltree, Terrance W.; (Lexington, KY), Robles, Cynthia A.; (New Richmond, WI) Correspondence: Office OF Intellectual Property Counsel; 3M Innovative Properties Company; PO Box 33427; ST. Paul; MN; 55133-3427; US Patent Application Number: 20020119187 Date filed: September 26, 2001 Abstract: A transdermal drug delivery composition comprises an acrylate copolymer and from about 8% to about 30% by weight fentanyl. A transdermal fentanyl delivery composition comprising methyl laurate or tetraglycol as a permeation enhancer is also provided. The transdermal drug delivery compositions can be used to make a transdermal drug delivery device for the delivery of fentanyl. Excerpt(s): This application claims priority to U.S. Provisional Patent Application No. 60/236,973, filed Sep. 29, 2000 and to U.S. Provisional Patent Application No. 60/284,017, filed Apr. 16, 2001. The present invention relates to a transdermal drug delivery composition containing fentanyl. The invention further relates to a transdermal drug delivery device for the delivery of fentanyl and to methods of providing sustained analgesia to subjects in need thereof. Transdermal drug delivery devices are designed to deliver a therapeutically effective amount of drug across the skin of a patient. Transdermal drug delivery devices typically involve a carrier (such as a liquid, gel, or solid matrix, or a pressure sensitive adhesive) into which the drug to be delivered is incorporated. Devices known to the art include reservoir type devices involving membranes that control the rate of drug release to the skin and devices where the drug is dispersed or dissolved in a matrix such as a pressure sensitive adhesive. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
10
This has been a common practice outside the United States prior to December 2000.
Patents 95
•
Detection of abused substances and their metabolites using nucleic acid sensor molecules Inventor(s): Seiwert, Scott; (Pacifica, CA) Correspondence: Mcdonnell Boehnen Hulbert & Berghoff; 300 South Wacker Drive; Suite 3200; Chicago; IL; 60606; US Patent Application Number: 20030224435 Date filed: May 16, 2003 Abstract: Nucleic acid sensor molecules (allozymes, allosteric ribozymes, allosteric DNAzymes), aptamers and methods are provided for the detection and quantitation of small molecules, including drugs, drug analogs, and drug metabolites, for example recreational drugs, mood-altering drugs, and performance enhancing drugs such as 4MTA (4-methylthioamphetamine), Alpha-ethyltryptamine, Amphetamine, Amyl nitrite, Benzocaine, Cocaine, Dimethyltryptamine, Ecstasy (MDA, MDMA, MDEA), Ephedrine, Erythropoietine (Epogen), Fentanyl, Gamma Hydroxybutyrate (GHB), GBL (Gamma butyrolactone), GHB (Gamma Hydroxybutyrate), Hashish, Heroin, Isobutyl nitrite, Ketamine, Lidocaine, LSD (Lysergic acid diethylamide), Mannitol, Marijuana (THC), Mescaline, Methadone, Methamphetamine, Methaqualone, Methcathinone, Methylphenidate (ritalin), Morphine, Nexus (2CB), Nicotine, Opium, Oxycodone, OxyContin, PCP (phencyclidine), Peyote, Phenobarbital, Procaine, Psilocybin, Psilocybin/psilocin, Pseudoephedrine, Rohypnol, Scopolamine, Steroids, Strychnine, and Talwin. Also provided are kits for detection. The nucleic acid sensor molecules, methods and kits provided herein can be used in diagnositic applications for detecting drugs, analogs, and metabolites thereof. Excerpt(s): This patent application claims the benefit of U.S. Ser. No. 60/381,006, filed May 16, 2002. This application is hereby incorporated by reference herein in its entirety including the drawings. This invention relates generally to the field of drug and drug metabolite detection in biological samples. More specifically, it provides a system for detecting or confirming the presence of a particular drug analyte in a sample that potentially contains interfering substances. This invention specifically relates to novel molecular sensors that utilize enzymatic nucleic acid constructs whose activity can be modulated by the presence or absence of signaling agents that include compounds and substances of abuse, such as recreational drugs, mood altering drugs, performance enhancing drugs, analgesics, and metabolites thereof. The present invention further relates to the use of the enzymatic nucleic acid constructs as molecular sensors capable of modulating the activity, function, or physical properties of other molecules useful in detecting compounds and substances of abuse and metabolites thereof. The invention also relates to the use of the enzymatic nucleic acid constructs as diagnostic reagents, useful in identifying such signaling agents in a variety of applications, for example, in screening biological samples or fluids for compounds and substances of abuse and metabolites thereof. The ability to perform rapid screening tests in diagnostic analysis of biological samples has been considerably facilitated by the evolving art of immunoassay. Antibodies can be raised that have exquisite specificity and sensitivity for small molecules of diagnostic interest, such as drugs and drug metabolites. In combination with other reagents that have a separating or labeling function, specific antibodies can be used as part of a rapid screening test for the presence of the small molecule in a clinical sample. Similarly, nucleic acid technology can be applied to develop polynucleotide based detection systems comprising nucleic acid molecules with high affinity for a particular small molecule target. Furthermore, the functionality of enzymatic nucleic acid molecules can be coupled with these recognition properties in
96
Fentanyl
the design of nucleic acid sensor molecules having both recognition and signal generating capability. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Device for transdermal electrotransport delivery of fentanyl and sufentanil Inventor(s): Bernstein, Keith J.; (Somerville, NJ), Noorduin, Henk; (Bergen op Zoom, NL), Southam, Mary; (Menlo Park, CA) Correspondence: Alza Corporation; Intellectual Property Department, M10-3; 1900 Charleston Road; P.O. Box 7210; Mountain View; CA; 94039-7210; US Patent Application Number: 20010018582 Date filed: February 9, 2001 Abstract: The invention provides an improved electrotransport drug delivery system for analgesic drugs, namely fentanyl and sufentanil. The fentanyl/sufentanil is provided as a water soluble salt (e.g., fentanyl hydrochloride), preferably in a hydrogel formulation, for use in an electrotransport device (10). In accordance with the present invention, a transdermal electrotransport delivered dose of fentanyl/sufentanil is provided which is sufficient to induce analgesia in (e.g., adult) human patients suffering from moderate-tosevere pain associated with major surgical procedures. Excerpt(s): The invention relates generally to improved electrotransport drug delivery. Specifically, the invention relates to a device, composition and method for improved electrotransport delivery of analgesic drugs, particularly fentanyl and analogs of fentanyl. A composition is provided in the form of a hydrogel formulation for use in an electrotransport device. The transdermal delivery of drugs, by diffusion through the epidermis, offers improvements over more traditional delivery methods, such as subcutaneous injections and oral delivery. Transdermal drug delivery avoids the hepatic first pass effect encountered with oral drug delivery. Transdermal drug delivery also eliminates patient discomfort associated with subcutaneous injections. In addition, transdermal delivery can provide more uniform concentrations of drug in the bloodstream of the patient over time due to the extended controlled delivery profiles of certain types of transdermal delivery devices. The term "transdermal" delivery, broadly encompasses the delivery of an agent through a body surface, such as the skin, mucosa, or nails of an animal. The skin functions as the primary barrier to the transdermal penetration of materials into the body and represents the body's major resistance to the transdermal delivery of therapeutic agents such as drugs. To date, efforts have been focused on reducing the physical resistance or enhancing the permeability of the skin for the delivery of drugs by passive diffusion. Various methods for increasing the rate of transdermal drug flux have been attempted, most notably using chemical flux enhancers. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Patents 97
•
Fentanyl composition for nasal administration Inventor(s): Grarup, Jesper; (Roskilde, DK), Nielsen, Hanne Wulf; (Svenborg, DK) Correspondence: Wenderoth, Lind & Ponack, L.L.P.; 2033 K Street N. W.; Suite 800; Washington; DC; 20006-1021; US Patent Application Number: 20040034059 Date filed: July 14, 2003 Abstract: The treatment of acute pain with a sufficient dosage by intranasal administration of fentanyl results in a time to onset of action comparable to intravenous administration and a significantly faster onset of action than nasal titration of fentanyl. The nasal administration of a sufficient amount of fentanyl to obtain pain relief has lower maximum plasma concentrations comparable to intravenous administration and results in lower rates of adverse events like respiratory depression, nausea and vomiting. Compositions fur use in the method are also disclosed. Excerpt(s): The present invention relates to a pharmaceutical composition for use in the treatment of acute pain such as breakthrough pain by means of a non-invasive administration of fentanyl or a pharmaceutically acceptable salt thereof, said composition being such that at least 70.mu.g of fentanyl is delivered in a dosage unit. The method comprises administration of a treatment dosage sufficient to treat the acute pain with time to onset of action comparable to intravenous administration. The treatment typically comprises intranasal administration of a relatively concentrated composition of fentanyl citrate. In addition, the invention relates to a pharmaceutical kit comprising a treatment dosage of fentanyl for nasal administration for treatment of acute pain together with a delivery system of an analgesic for a continuous treatment of chronic pain. Fentanyl is a potent narcotic analgesic with pharmacological effects similar to morphine. Fentanyl is 50 to 100 times more potent than morphine on a weight basis. Fentanyl is a mu-receptor agonist acting on receptors distributed in the brain, spinal cord and other tissues. Opioids produce both analgesia and sedation. Opiate agonists appear to prevent the release of beta-endorphin, possibly by altering the patients perceived level of pain and anxiety, although the presence of pain may still be recognised (1). Parenteral fentanyl is indicated for anaesthesia, treating postoperative pain, and as a premedicant. Transdermal fentanyl is used for managing chronic pain in patients requiring opioids. Fentanyl lozenge/sucker (Oralet.RTM.) is indicated to induce anxiolysis and analgesia prior to surgery in pediatric and adult patients. Oral transmucosal fentanyl (Actiq.RTM.) is indicated for the management of breakthrough cancer pain in adults with malignancies who are already receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain. Fentanyl Oralet.RTM. is only indicated for use in a hospital setting as an anaesthetic pre-medication in the operating room setting or to induce conscious sedation prior to a diagnostic or therapeutic procedure in other monitored anaesthesia care settings in the hospital. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
98
•
Fentanyl
Implantable devices and methods for treatment of pain by delivery of fentanyl and fentanyl congeners Inventor(s): Brown, James; (US), Culwell, John; (US), Dinka, John; (US), Filice, James; (US), Gillis, Edward M.; (Cupertino, CA), Johnson, Randolph Mellus; (Half Moon Bay, CA), Laidlaw, Barbara; (US), Litmanovitz, Dana; (US), Poutiatine, Andrew; (US), Theeuwes, Felix; (Los Altos Hills, CA), Wickman, Peter; (US), Yum, Su-ll; (US) Correspondence: Bozicevic, Field & Francis Llp; 200 Middlefield RD; Suite 200; Menlo Park; CA; 94025; US Patent Application Number: 20030088236 Date filed: June 27, 2002 Abstract: The invention features devices and methods for treatment of pain. The drug delivery device is a drug delivery system adapted for whole implantation in a subject and to provide pain relief by delivery of fentanyl or a fentanyl congener (e.g., sufentanil) over a protracted period of time (e.g., at least 3 days or more than 3 days). The device comprises a housing defining a reservoir that contains a drug formulation, a pump operatively connected to the housing so as to facilitate movement of drug out of the reservoir and out of the device, and a thermal expansion element which defines a flow pathway comprising a thermal expansion channel to accommodate thermal expansion of formulation in the reservoir. The device can further comprise a valve positioned within the flow pathway so as to prevent movement of drug out of the reservoir prior to use. Excerpt(s): each of which applications is hereby incorporated by reference in its entirety. The invention relates to devices and methods for the management of pain. Particularly, the invention relates to an implanted drug delivery device used to deliver a potent painkilling drug over a protracted period of time. Many medications are used for the treatment of pain, ranging from well known, over-the-counter compounds such as aspirin, acetaminophen, ibuprofen and other non-steroidal anti-inflammatory compounds to the newly developed chemical entities such as the cyclooxygenase II inhibitor compounds. Opiates in various forms, including opium, heroine and morphine which derive from the opium poppy, have very powerful analgesic properties. Opiates have been widely used for anesthesia as well for the treatment of pain, especially where the pain is very severe. In addition to these natural opiates, many synthetic opioids have since been synthesized including methadone, fentanyl and congeners of fentanyl such as sufentanil, alfentanil, lofentanil, carfentanil, remifentanil, etc. Of the opioids, morphine is still the drug of choice for management of pain at least in part due to its low cost, the ability of the drug to provide relief from pain of a variety of origins, and the vast experience with this drug. Despite its therapeutic advantages and vast experience with the drug, many pain management experts believe that morphine and other opioids are under-prescribed for patients who require long-term pain therapy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Patents 99
•
Method and kit for detecting, or determining the quantity of, metabolites of fentanyl and metabolites of fentanyl analogs Inventor(s): Benchikh, Elouard; (Antrim, GB), Fitzgerald, Stephen Peter; (Crumlin, GB), Lamont, John Victor; (Crumlin, GB), McConnell, Robert Ivan; (Ballymena, GB) Correspondence: Woodcock Washburn Llp; One Liberty Place, 46th Floor; 1650 Market Street; Philadelphia; PA; 19103; US Patent Application Number: 20030170728 Date filed: November 15, 2002 Abstract: The invention provides an immunogen comprising a hapten coupled to an antigenicity-conferring carrier material, a conjugate comprising the aforementioned hapten coupled to a labelling agent, as well as, antibodies raised against the aforementioned immunogen and capable of binding with at least one structural epitope of metabolites of fentanyl and of metabolites of fentanyl analogs. Excerpt(s): The present invention relates to a method and kit for detecting, or determining the quantity of, metabolites, preferably nor-metabolites, both of fentanyl and of its analogs, as well as, immunogens, conjugates and antibodies useful therein. By "detecting" is meant qualitatively analysing for the presence or absence of a substance. By "determining" is meant quantitatively analysing for the amount of a substance present. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
•
Method for administering an analgesic Inventor(s): Novack, Gary D.; (San Rafael, CA), Schneider, Stephen A.; (Palo Alto, CA) Correspondence: Mika Mayer; Morrison & Foerster Llp; 755 Page Mill Road; Palo Alto; CA; 94304-1018; US Patent Application Number: 20030138508 Date filed: December 17, 2002 Abstract: A method is provided to parenterally administering an analgesic (i.e., fentanyl) to a patient in the presence of a cannabinoid receptor agonist. This has been found to unexpectedly result in an almost order of magnitude increase in the therapeutic index over that of administering fentanyl alone. The respective amounts of the cannabinoid receptor agonist and fentanyl are selected to achieve the therapeutic index of the analgesic is greater than about 1000. While the method of the present invention contemplates administering the drug by all the medication routes other than orally, the preferred route is via inhalation. Excerpt(s): This application claims priority to U.S. provisional application Serial No. 60/342,066 entitled "Method for Administering an Analgesic," filed Dec. 18, 2001, Gary Novak and Stephen A. Schneider, the entire disclosure of which is hereby incorporated by reference. This application further claims priority to U.S. provisional application Serial No. 60/412,068 entitled "Method for Administering an Analgesic," filed Sep. 18, 2002, Gary D. Novack and Stephen A. Schneider, the entire disclosure of which is hereby incorporated by reference. This invention relates to a method for parenterally administering to a patient an analgesic in the presence of a cannabinoid receptor agonist. It is well known that THC and other extracts of cannabinoid affect both peripheral and central nervous system activity. Behavioral effects of such compounds
100
Fentanyl
are characterized at low doses as a mixture of depressant and stimulatory effects and at higher doses as predominantly CNS depressants (Dewey, 1986). The depressant effects of cannabinoids produce hyperreflexia. Cannabinoids generally cause a reduction in spontaneous locomotor activity and a decrease in response rates. Cannabinoids also impair learning and memory in rodents and non-human primates. Other effects that have been shown in the mouse include hypothermia (Compton et al., 1993), immobility (catalepsy) and antinociception, which comprise the "tetrad" of tests for cannabinoid activity (Martin, 1985). The mechanisms which underly the other effects of the cannabinoids as tested in the "tetrad" have been shown to be pertussis toxin-senstitive (Lichtman et al., 1996) and thus, are likely mediated via G-protein activation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Opioid agonist in a fast dispersing dosage form Inventor(s): Johnson, Edward Stewart; (Ruscombe, GB), Lacy, Jon; (Genthod, CH) Correspondence: Donald O. Nickey; Cardinal Health, Inc; 7000 Cardinal Place; Dublin; OH; 43017; US Patent Application Number: 20040037882 Date filed: August 25, 2003 Abstract: This invention relates to a pharmaceutical composition for oral administration comprising a carrier and, as active ingredient, an opioid (.mu. receptor) agonist, such as fentanyl, or a salt thereof, characterized in that the composition is in the form of a fastdispersing dosage form designed to release the active ingredient rapidly in the oral cavity. A process for preparing such a composition and the use of such a composition as an analgesic, for the treatment of chronic pain and/or breakthrough pain, as an anesthetic premedication, for the induction of anesthesia, as a sedative and/or for the treatment of anxiety are also provided. Excerpt(s): This application is a continuation of U.S. patent application Ser. No. 09/936,060 filed Jan. 14, 2002, now U.S. Pat. No. ______, which claims the benefit of priority to Great Britain Application No. 9904911.6 filed Mar. 3, 1999. This invention relates to a pharmaceutical composition in the form of a fast dispersing dosage form and to a process for preparing such a composition. The invention also relates to the use of such a composition as an analgesic for the treatment of chronic pain and/or breakthrough pain, as an anesthetic premedication for the induction of anesthesia as a sedative and as a treatment for anxiety. Fentanyl (N-phenyl-N-[1-(2-phenylethyl)-4piperidinyl]propanamide) is a potent synthetic opioid (.mu. receptor) agonist, related to pethidine, which possesses a fast onset and a moderate duration of action. The agonists useful in the present invention are chemical substances capable of combining with a receptor on a cell and initiating a reaction or activity that is characteristics of opiate narcotics, but which is not derived from opium. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Patents 101
•
Opioid formulations Inventor(s): Laidlaw, Barbara J F; (San Jose, CA), Litmanovitz, Dana; (Sunnyvale, CA) Correspondence: Bozicevic, Field & Francis Llp; 200 Middlefield RD; Suite 200; Menlo Park; CA; 94025; US Patent Application Number: 20030212106 Date filed: January 23, 2003 Abstract: The present invention provides high-concentration formulations of opioids such as fentanyl or fentanyl congeners. The formulation of the invention comprises fentanyl or a fentanyl congener in concentrations significantly in excess of conventional formulations, e.g., on the order about 2-fold to about 10,000-fold greater than conventional formulations, e.g., currently commercially available formulations. These formulations are particularly useful for long-term delivery to a subject suffering from pain. The invention further provides drug delivery devices comprising the highconcentration opioid formulations, and further provides methods of alleviating pain in a subject, comprising administering the high-concentration formulations to a subject in need thereof. Excerpt(s): The invention relates to high-concentration formulations of opioids to alleviate pain. Opiates in various forms, including opium, heroine and morphine which derive from the opium poppy, have very powerful analgesic properties and have seen widespread use for anesthesia as well the treatment of pain, especially where the pain is very severe. In addition to these natural opiates, many synthetic opioids have since been synthesized including fentanyl and congeners of fentanyl such as sufentanil, alfentanil, lofentanil, carfentanil, remifentanil, etc., which are many times more potent than morphine. At present, the dosage form with the most widespread use is still morphine administered orally, although opioids can also be delivered by intravenous infusion (see, e.g., Scholz et al. 1996 Clin. Pharmacokinet. 31:275-92; White 1989 Anesth. Analg. 68:161-71), oral administration, (see, e.g., U.S. Pat. Nos. 4,769,372; 5,202,128; and 5,378,474), epidural or intrathecal administration (see, e.g., Vercauteren et al. 1998 Anaesthesia 53:1022-7; Stephens 1997 Am. Fam. Physician 56:463-70), transdermal application (e.g., using a transdermal patch (see, e.g., U.S. Pat. No. 4,588,580)), or subcutaneous injection (see, e.g., Paix et al. 1995 Pain 63:263-9; Bruera et al. 1988 Cancer 62:407-11; Moulin et al. 1992 Can. Med. Assoc. J. 146:891-7). For a review, see, e.g., Clotz et al. 1991 Clin. Pharm. 10:581-93; and Anderson et al. 1998 J. Pharm. Care Pain Symptom Control 6:5-21. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
•
Orally-bioavailable formulations of fentanyl and congeners thereof Inventor(s): Shao, Liming; (Lincoln, MA) Correspondence: Foley Hoag Llp; Patent Group; 155 Seaport Boulevard; Boston; MA; 02110; US Patent Application Number: 20020160991 Date filed: October 26, 2001 Abstract: One aspect of the present invention relates to formulations of fentanyl and its congeners. A second aspect of the present invention relates to the use of the formulations of the present invention as analgesics in mammals.
102
Fentanyl
Excerpt(s): This application claims the benefit of priority to U.S. Provisional Patent Application serial No. 60/251,144, filed Dec. 4, 2000. Pain is an unpleasant sensation varying in severity in a local part of the body or several parts of the body resulting from injury, disease, or emotional disorder. Pain can be classified according to its duration. Acute pain, which lasts less than one month, usually has a readily identifiable cause and signals tissue damage. In addition, acute pain syndromes can be episodic, for example recurrent discomfort from arthritis. Chronic pain can be defined as pain that persists more than one month beyond the usual course of an acute illness or injury, or pain that recurs at intervals over months or years, or pain that is associated with a chronic pathologic process. In contrast to acute pain, chronic pain loses its adaptive biologic function. Depression is common, and abnormal illness behavior often compounds the patient's impairment. Millions of people suffer from chronic or intractable pain. Persistent pain varies in etiology and presentation. In some cases, symptoms and signs may be evident within a few weeks to a few months after the occurrence of an injury or the onset of disease, e.g. cancer or AIDS. Like many illnesses that at one time were not well understood, pain and its many manifestations may be poorly treated and seriously underestimated. Inappropriately treated pain seriously compromises the patient's quality of life, causing emotional suffering and increasing the risk of lost livelihood and disrupted social integration. Severe chronic pain affects both the pediatric and adult population, and often leads to mood disorders, including depression and, in rare cases, suicide. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Pharmaceutical compositions Inventor(s): Ross, Calvin; (Hants, GB) Correspondence: Mintz, Levin, Cohn, Ferris, Glovsky; And Popeo, P.C.; One Financial Center; Boston; MA; 02111; US Patent Application Number: 20030190290 Date filed: May 28, 2003 Excerpt(s): The present invention relates to compositions and dispensing devices for improved administration of fentanyl and other opioid analgesics, such as alfentanil, carfentanil, remifentanil, sufentanil, buprenorphine, morphine, diamorphine, and the like. Opioid analgesics are frequently used for the relief of moderate to severe pain, as well as in anaesthesia. The present invention relates primarily to the use of fentanyl and other opioid analgesics in pain management and in particular to the treatment of acute pain or "break-through" pain. Ideally, this type of pain relief has rapid onset. Fentanyl and other opioid analgesics have rapid effect following administration, making them particularly suited for the treatment of break-through pain. Nevertheless, onset of their analgesic effect can be slowed considerably if there is a delay between administration and uptake of the active agent into the blood. Such delay means that certain modes of administration are unsuitable for treatment requiring rapid onset and are therefore not to be used in the treatment of break-through pain. A particularly important consideration when administering opioid analgesics is that the doses are accurately controlled and are reproducible. Firstly, it is imperative that the patient does not overdose. Large doses of opioid analgesics may lead to respiratory depression and some euphoric activity, which can lead to abuse and dependency. Secondly, it is undesirable for the patient to be provided with a dose which is too small, as such a dose is likely to provide inadequate pain-relief.
Patents 103
Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Programmable controlled release injectable opioid formulation Inventor(s): Rubsamen, Reid M.; (Alamo, CA) Correspondence: Bozicevic, Field & Francis Llp; 200 Middlefield RD; Suite 200; Menlo Park; CA; 94025; US Patent Application Number: 20030055075 Date filed: July 12, 2002 Abstract: Controlled release formulations of drugs such as fentanyl and sufentanil are disclosed. The formulations are comprised of two or more different groups of particles wherein the particles of a given group are substantially identical but are different from the particles in any other group. The combined effect of the groups provides steady state blood levels which are particularly useful when administering opioids compound such as fentanyl by injection. A method of reducing unwanted diversion of narcotics is also disclosed. Excerpt(s): This application is the conversion of provisional applications Nos. 60/305,364 filed Jul. 13, 2001 and 60/326,675 filed Oct. 2, 2001 to which applications is claimed priority and which applications are incorporated herein by reference. The invention relates generally to drug delivery technology and more particularly to formulations of spherical particles designed to provide a particular release profile on administration. Further, the invention relates to a method of reducing unwanted diversion of narcotics away from the desired patient. The various controlled release technologies cover a very broad spectrum of drug dosage forms. Controlled release technologies include, but are not limited to physical systems and chemical systems. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
•
Transdermal administration of fentanyl and analogs thereof Inventor(s): Gale, Robert M.; (Los Altos, CA), Li, Shaoling; (Sunnyvale, CA), Stepic, Jane; (San Carlos, CA), Van Osdol, William W.; (Mountain View, CA), Venkatraman, Subramanian S.; (Singapore, SG) Correspondence: Alza Corporation; P O Box 7210; Intellectual Property Department; Mountain View; CA; 940397210 Patent Application Number: 20030026829 Date filed: March 15, 2002 Abstract: A method and a non-rate controlled, monolithic, subsaturated patch for transdermally administering fentanyl and analogs thereof, for analgetic purposes, to a subject through skin over an extended period of time are disclosed. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/276837, filed on Mar. 16, 2001. The present invention relates to a method and a patch for the transdermal administration of fentanyl and analogs thereof for analgetic purposes. In particular, the invention relates to a subsaturated patch for administering fentanyl and analogs thereof to a subject through skin over an extended period of time. Fentanyl and analogs thereof, such as alfentanil, carfentanil, lofentanil, remifentanil, sufentanil, trefentanil and the like, are powerful synthetic opioids which have
104
Fentanyl
demonstrated utility in both human and veterinary medicine. In human medicine, alfentanil, fentanyl, remifentanil and sufentanil have been granted regulatory approval for use as general anesthetics. A fentanyl containing lollipop for oral transmucosal administration and a fentanyl containing transdermal patch have also been approved as analgesics for use in the treatment of chronic pain. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Transdermal drug patch Inventor(s): Zhang, Jie; (Salt Lake City, UT) Correspondence: Michael F. Krieger; Kirton & Mcconkie; 1800 Eagle Gate Tower; 60 East South Temple; Salt Lake City; UT; 84111; US Patent Application Number: 20010033858 Date filed: February 28, 2001 Abstract: The present invention is directed toward a formulation for supplying additional drug for delivery in a transdermal drug delivery device. The invention comprises a drug, such as fentanyl that is capable of transdermal delivery, and a solution having a pre-designed solubility for the drug. The solution dissolves only a portion of said drug and allows a significant portion of the drug to remain undissolved in solution, thus providing extra drug to be delivered at a consistent, controlled delivery rate. The invention may used in conjunction with controlled heat. Excerpt(s): This application claims priority to U.S. Provisional Application No. 60/185,893 filed Feb. 29, 2000. The present invention is directed toward an improved transdermal drug delivery patch. More specifically, the present invention is directed toward improving drug deliver patches for use with temperature modification devices. Transdermal drug delivery to administer drugs to patients is an effective and efficient method for delivering certain drugs to patients. Transdermal drug delivery is convenient, noninvasive, and in some cases provides a more effective method for delivering a drug. However, transdermal drug delivery patches have a number of limitations and disadvantages. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
•
Transdermal system with fentanyl Inventor(s): Fischer, Wilfried; (Vagen, DE), Leichs, Christian; (Miesbach, DE), TisaBostedt, Katalin; (Pullach, DE) Correspondence: Cohen, Pontani, Lieberman & Pavane; 551 Fifth Avenue; Suite 1210; New York; NY; 10176; US Patent Application Number: 20040001882 Date filed: March 5, 2003 Abstract: This invention relates to a transdermal system containing fentanyl as the active ingredient and consisting of or comprisinga substrate,a mixture of the following ingredients applied to the substrate:the active ingredient,an oil-based aloe vera extract,a resin, andan adhesive, as well asa layer laminated to the mixture applied to the substrate.
Patents 105
Excerpt(s): Transdermal administration of fentanyl is known for treatment of postoperative pain and pain associated with a tumor (see U.S. Pat. No. 4,588,580). In addition to the general applicability of fentanyl and its derivatives, this patent also describes pharmaceutical forms for transdermal administration. These are reservoir systems, which have a liquid reservoir for the active ingredient with an absorption enhancer on the one hand and also a solid reservoir for the active ingredient on the other hand. experience has shown that liquid solvents lead to a reduced adhesive power of the pressure-sensitive adhesive over the storage time. skin irritation due to the liquid solvent/dispersant. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Ultrashort-acting opioids for transdermal application Inventor(s): Druzgala, Pascal; (Santa Rosa, CA) Correspondence: David R. Saliwanchik; Saliwanchik, Lloyd & Saliwanchik; A Professional Association; 2421 N.W. 41st Street, Suite A-1; Gainesville; FL; 32606-6669; US Patent Application Number: 20020183343 Date filed: April 3, 2002 Abstract: The subject invention concerns novel analogs of fentanyl opioids. The subject invention also concerns methods for synthesizing the compounds of the invention. The invention also concerns methods for treating pain in a patient by administering a compound of the invention to a person in need of such treatment. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/281,080, filed Apr. 3, 2001. Fentanyl is an opioid analgesic that is roughly onehundred fold more potent than morphine. Chemically, it is a 1,4-disubstituted piperidine molecule with agonist properties at the.mu.-opioid receptor. This type of receptor is found in the brain as well as in various peripheral tissues and in the spinal chord. A transdermal delivery system for fentanyl has been described. This system delivers fentanyl at rates between 25 and 100.mu.g/hour. Due to severe side effects, the fentanyl transdermal system described in the art is indicated only in the management of chronic pain in patients requiring continuous opioid analgesia for pain that cannot be managed by lesser means. Because serious or life-threatening hypoventilation could occur, the use of fentanyl transdermal treatment is strongly contraindicated in children younger than 12 years of age, in the management of acute or post-operative pain, including use in outpatient surgery, and in general in any situation where pain can be managed by non-opioid therapy. The development of a short-acting transdermal fentanyl analog system would be of great value. A soft fentanyl analog has been described in the art. Remifentanyl (Ultiva.RTM.) is marketed by Glaxo Wellcome as an ultrashort acting opioid for intravenous analgesia in anaesthetic cocktails. Due to its high degree of efficiency against extreme pain, a safe soft analog of fentanyl could be used in cases of pain management that are not presently suitable for the current opioid therapy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
106
Fentanyl
Keeping Current In order to stay informed about patents and patent applications dealing with fentanyl, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “fentanyl” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on fentanyl. You can also use this procedure to view pending patent applications concerning fentanyl. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
107
CHAPTER 6. BOOKS ON FENTANYL Overview This chapter provides bibliographic book references relating to fentanyl. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on fentanyl include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “fentanyl” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “fentanyl” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “fentanyl” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Transdermal Fentanyl by D. Zech (Editor), K. A. Lehmann; ISBN: 0387544402; http://www.amazon.com/exec/obidos/ASIN/0387544402/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “fentanyl” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 11 In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed
108
•
Fentanyl
Use of naloxone for reversal of fentanyl-supplemented anaesthesia. Author: by Irma Tigerstedt; Year: 1977
Chapters on Fentanyl In order to find chapters that specifically relate to fentanyl, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and fentanyl using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “fentanyl” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on fentanyl: •
Drugs Used for Vertigo and Vomiting Source: in Bennett, D.R., ed. Drug Evaluations Annual 1994. Chicago, IL: American Medical Association, Division of Toxicology. 1994. p. 439-464. Contact: Available from American Medical Association. Division of Drugs and Toxicology, 515 North State Street, Chicago, IL 64610. (312) 464-500. ISBN: 0899706029. PRICE: $78.00 for AMA members, $98.00 for nonmembers. Summary: This chapter discusses drugs that are effective in combating vertigo or nausea and vomiting. The vertigo section includes a description of vertigo; its causes; subjective vertigo; drug-induced vertigo; and Meniere's disease. The section also includes a discussion of drug selection for antivertigo drugs. Drugs discussed include scopolamine; antihistaminic drugs; antianxiety agents and antidepressants; diazepam (Valium); droperidol (Innovar); and fentanyl citrate (Sublimaze). The chapter concludes with the chemical formation, and a discussion of uses, adverse reactions and precautions, and dosage and preparations for each of the pharmaceuticals discussed. 1 table. 101 references.
in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
109
CHAPTER 7. PERIODICALS AND NEWS ON FENTANYL Overview In this chapter, we suggest a number of news sources and present various periodicals that cover fentanyl.
News Services and Press Releases One of the simplest ways of tracking press releases on fentanyl is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “fentanyl” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to fentanyl. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “fentanyl” (or synonyms). The following was recently listed in this archive for fentanyl: •
Fentanyl patch safe, effective for long-term relief of cancer pain Source: Reuters Industry Breifing Date: December 05, 2003
•
FDA approves Mylan's form of Duragesic pain patch Source: Reuters Industry Breifing Date: November 24, 2003
110
Fentanyl
•
Cephalon licenses Japanese Actiq rights to Tanabe Source: Reuters Industry Breifing Date: March 18, 2003
•
Oral transmucosal fentanyl improves QOL in patients with severe, nonmalignant pain Source: Reuters Industry Breifing Date: November 29, 2002
•
Russia says siege gas based on fentanyl-agencies Source: Reuters Health eLine Date: October 30, 2002
•
Generex files to begin fentanyl testing in Canada Source: Reuters Industry Breifing Date: August 19, 2002
•
Generex buccal fentanyl acts as fast as injected drug in study Source: Reuters Industry Breifing Date: April 30, 2002
•
Transdermal fentanyl preferred over other opioids for chronic pain Source: Reuters Industry Breifing Date: August 22, 2001
•
Novel fentanyl formulation treats breakthrough pain in cancer patients Source: Reuters Industry Breifing Date: August 14, 2001
•
Cephalon wins approval in Europe for cancer pain drug Actiq Source: Reuters Industry Breifing Date: June 28, 2001
•
Patients with chronic noncancer pain prefer transdermal fentanyl to oral morphine Source: Reuters Industry Breifing Date: May 10, 2001
•
FDA says fentanyl shortage resolved Source: Reuters Industry Breifing Date: March 27, 2001
•
Intranasal fentanyl citrate helpful in cancer-related breakthrough pain Source: Reuters Industry Breifing Date: November 15, 2000
•
Anesta announces UK Actiq approval, completion of Cephalon merger Source: Reuters Industry Breifing Date: October 10, 2000
•
Atrix will develop pain drug fentanyl in joint venture with Elan Source: Reuters Industry Breifing Date: October 04, 2000
•
Fast-acting fentanyl controls incidental pain during palliative radiation therapy Source: Reuters Industry Breifing Date: September 27, 2000
•
Transmucosal Fentanyl "Ideally Suited" For Cancer Breakthrough Pain Source: Reuters Medical News Date: April 17, 1998
Periodicals and News
•
111
Transmucosal Fentanyl Citrate Effective For Breakthrough Cancer Pain Source: Reuters Medical News Date: May 23, 1997 The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “fentanyl” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “fentanyl” (or synonyms). If you know the name of a company that is relevant to fentanyl, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “fentanyl” (or synonyms).
112
Fentanyl
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “fentanyl” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on fentanyl: •
Drug Therapy of Chronic Pain Source: Lifeline: The Newsletter of the National Chronic Pain Outreach Association. p. 6-8,10-12. Fall 1998. Contact: Available from National Chronic Pain Outreach Association. P.O. Box 274, Millboro, VA 24460. (540) 862-9437. Fax (540) 862-9485. E-mail:
[email protected]. Summary: This newsletter article provides health professionals and people who have chronic pain with information on the main classes of drugs used to treat pain. Medications are usually taken orally in the form of a pill, capsule, tablet, or liquid, but some may be delivered through creams, skin patches, inhalers, injections, spinal catheters, and rectal suppositories. The main drugs used to treat pain are the nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and a group referred to as adjuvant analgesics. NSAID classes include salicylates, propionic acids, acetic acids, fenamates, and oxicams. Opioid analgesics have long been an accepted therapeutic modality in the treatment of acute and chronic pain; however, concerns about dosage increases and addiction have lead to controversy over their use. Evidence indicates that these concerns are unfounded, so opioids are appropriate for pain management. Morphine and fentanyl are two opioid formulations uniquely made for management of chronic pain. Adjuvant analgesics are a mixed class of medications that may be used to provide additive analgesic effect and to counteract the side effects of more traditional analgesics. Adjuvant analgesics include tricyclic antidepressants, anticonvulsants, benzodiazepines, antihistamines, stimulants such as caffeine and dextroamphetamine, steroids, phenothiazines, oral local anesthetics, sympatholytics, sumatriptan, and topical capsaicin. The article discusses the rationale for selecting particular drugs over others, their mechanism of action, and their common side effects. 3 tables and 17 references.
Academic Periodicals covering Fentanyl Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to fentanyl. In addition to these sources, you can search for articles covering fentanyl that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles.
Periodicals and News
113
At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
115
CHAPTER 8. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for fentanyl. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with fentanyl. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The
116
Fentanyl
following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to fentanyl: Fentanyl •
Systemic - U.S. Brands: Actiq http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203780.html
•
Transdermal-Systemic - U.S. Brands: Duragesic http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202702.html
Narcotic Analgesics for Surgery and Obstetrics •
Systemic - U.S. Brands: Alfenta; Astramorph; Astramorph PF; Buprenex; Demerol; Duramorph; Nubain; Stadol; Sublimaze; Sufenta; Ultiva http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202391.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.
Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
117
APPENDICES
119
APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
•
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
•
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
•
National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
•
National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
•
National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
•
National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
•
National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
12
These publications are typically written by one or more of the various NIH Institutes.
120
Fentanyl
•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
•
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
•
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
•
National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
•
National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
•
National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
•
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
•
National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
•
National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
•
National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
•
National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
•
National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
•
National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
•
Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
•
National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
•
National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
•
Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
•
Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
Physician Resources
121
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
•
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
•
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
•
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
•
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
•
Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
•
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
•
Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
•
Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
•
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
•
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
13
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.
122
Fentanyl
•
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
•
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “fentanyl” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 12642 28 988 1 45 13704
HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “fentanyl” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
15
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
16
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
Physician Resources
123
Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
•
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
20 Adapted 21
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
125
APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on fentanyl can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to fentanyl. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to fentanyl. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “fentanyl”:
126
•
Fentanyl
Other guides Anabolic Steroids http://www.nlm.nih.gov/medlineplus/anabolicsteroids.html Cancer Chemotherapy http://www.nlm.nih.gov/medlineplus/cancerchemotherapy.html Drug and Medical Device Safety http://www.nlm.nih.gov/medlineplus/drugandmedicaldevicesafety.html Interstitial Cystitis http://www.nlm.nih.gov/medlineplus/interstitialcystitis.html Marijuana Abuse http://www.nlm.nih.gov/medlineplus/marijuanaabuse.html Prescription Drug Abuse http://www.nlm.nih.gov/medlineplus/prescriptiondrugabuse.html
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to fentanyl. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/specific.htm
•
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
•
Med Help International: http://www.medhelp.org/HealthTopics/A.html
•
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
Patient Resources
•
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
•
WebMD®Health: http://my.webmd.com/health_topics
127
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to fentanyl. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with fentanyl. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about fentanyl. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “fentanyl” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “fentanyl”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “fentanyl” (or synonyms) into the “For these words:”
128
Fentanyl
box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “fentanyl” (or a synonym) into the search box, and click “Submit Query.”
129
APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
23
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
130
Fentanyl
libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
•
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
•
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
•
California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
•
California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
•
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
•
California: Gateway Health Library (Sutter Gould Medical Foundation)
•
California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
•
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
•
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
•
California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
•
California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
•
California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
•
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
•
California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
•
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
•
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
•
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
24
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 131 •
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
•
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
•
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
•
Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
•
Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
•
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
•
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
•
Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
•
Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
•
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
•
Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
•
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
•
Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
•
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
•
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
•
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
•
Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
•
Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
•
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
•
Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
132
Fentanyl
•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
•
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
•
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
•
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
•
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
•
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
•
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
•
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
•
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
•
Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
•
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
•
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
•
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
•
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
•
Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
•
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
•
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
•
National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries 133 •
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
•
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
•
New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
•
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
•
New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
•
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
•
Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
•
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
•
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
•
Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
•
Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
•
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
•
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
•
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
•
Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
•
Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
134
Fentanyl
•
South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
•
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
•
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
•
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
135
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
•
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
137
FENTANYL DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetic Acids: Acetic acid and its derivatives which may be formed by substitution reactions. Mono- and di-substituted, as well as halogenated compounds have been synthesized. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenylate Cyclase: An enzyme of the lyase class that catalyzes the formation of cyclic AMP and pyrophosphate from ATP. EC 4.6.1.1. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH]
138
Fentanyl
Adrenalin: A hormone of the adrenal medulla. [NIH] Adrenaline: A hormone. Also called epinephrine. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic Agonists: Drugs that bind to and activate adrenergic receptors. [NIH] Adrenergic Antagonists: Drugs that bind to but do not activate adrenergic receptors. Adrenergic antagonists block the actions of the endogenous adrenergic transmitters epinephrine and norepinephrine. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]
Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Afferent Pathways: Nerve structures through which impulses are conducted from a peripheral part toward a nerve center. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agmatine: Decarboxylated arginine, isolated from several plant and animal sources, e.g., pollen, ergot, herring sperm, octopus muscle. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Alfentanil: A short-acting opioid anesthetic and analgesic derivative of fentanyl. It produces an early peak analgesic effect and fast recovery of consciousness. Alfentanil is effective as an anesthetic during surgery, for supplementation of analgesia during surgical procedures, and
Dictionary 139
as an analgesic for critically ill patients. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alprostadil: A potent vasodilator agent that increases peripheral blood flow. It inhibits platelet aggregation and has many other biological effects such as bronchodilation, mediation of inflammation, etc. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Aminophylline: A drug combination that contains theophylline and ethylenediamine. It is more soluble in water than theophylline but has similar pharmacologic actions. It's most common use is in bronchial asthma, but it has been investigated for several other applications. [NIH]
140
Fentanyl
Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnesia: Lack or loss of memory; inability to remember past experiences. [EU] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]
Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anti-Anxiety Agents: Agents that alleviate anxiety, tension, and neurotic symptoms, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. Some are also effective as anticonvulsants, muscle relaxants, or anesthesia adjuvants. Adrenergic beta-antagonists are commonly used in the symptomatic treatment of anxiety but are not included here. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or
Dictionary 141
reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antidiuretic: Suppressing the rate of urine formation. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antispasmodic: An agent that relieves spasm. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Aphonia: Complete loss of phonation due to organic disease of the larynx or to nonorganic (i.e., psychogenic) causes. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in
142
Fentanyl
the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arrestin: A 48-Kd protein of the outer segment of the retinal rods and a component of the phototransduction cascade. Arrestin quenches G-protein activation by binding to phosphorylated photolyzed rhodopsin. Arrestin causes experimental autoimmune uveitis when injected into laboratory animals. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthroscopy: Endoscopic examination, therapy and surgery of the joint. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspartate: A synthetic amino acid. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Atrial: Pertaining to an atrium. [EU] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous
Dictionary 143
systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Axilla: The underarm or armpit. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]
Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Beclomethasone: An anti-inflammatory, synthetic glucocorticoid. It is used topically as an anti-inflammatory agent and in aerosol form for the treatment of asthma. [NIH] Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Beta-Endorphin: A peptide consisting of amino acid sequence 61-91 of the endogenous pituitary hormone beta-lipotropin. The first four amino acids show a common tetrapeptide sequence with methionine- and leucine enkephalin. The compound shows opiate-like activity. Injection of beta-endorphin induces a profound analgesia of the whole body for several hours. This action is reversed after administration of naloxone. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Bioavailable: The ability of a drug or other substance to be absorbed and used by the body. Orally bioavailable means that a drug or other substance that is taken by mouth can be absorbed and used by the body. [NIH]
144
Fentanyl
Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Flow Velocity: A value equal to the total volume flow divided by the cross-sectional area of the vascular bed. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bolus injection: The injection of a drug (or drugs) in a high quantity (called a bolus) at once, the opposite of gradual administration (as in intravenous infusion). [EU] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled
Dictionary 145
with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchial Spasm: Spasmodic contraction of the smooth muscle of the bronchi. [NIH] Bronchiseptica: A small, gram-negative, motile bacillus. A normal inhabitant of the respiratory tract in man, dogs, and pigs, but is also associated with canine infectious tracheobronchitis and atrophic rhinitis in pigs. [NIH] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH] Bronchus: A large air passage that leads from the trachea (windpipe) to the lung. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bupivacaine: A widely used local anesthetic agent. [NIH] Buprenorphine: A derivative of the opioid alkaloid thebaine that is a more potent and longer lasting analgesic than morphine. It appears to act as a partial agonist at mu and kappa opioid receptors and as an antagonist at delta receptors. The lack of delta-agonist activity has been suggested to account for the observation that buprenorphine tolerance may not develop with chronic use. [NIH] Butorphanol: A synthetic morphinan analgesic with narcotic antagonist action. It is used in the management of severe pain. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caesarean section: A surgical incision through the abdominal and uterine walls in order to deliver a baby. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a
146
Fentanyl
pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Cannabidiol: Compound isolated from Cannabis sativa extract. [NIH] Cannabinoids: Compounds extracted from Cannabis sativa L. and metabolites having the cannabinoid structure. The most active constituents are tetrahydrocannabinol, cannabinol, and cannabidiol. [NIH] Cannabinol: A physiologically inactive constituent of Cannabis sativa L. [NIH] Capping: A 7-methyl guanosine cap attached to the 5'-end of eucaryotic mRNAs by a phosphodiester linkage. The cap is believed to increase the stability of the message, since most nucleases require a 5'-3'or 3'-5'bond in order to cleave the RNA. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH]
Dictionary 147
Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catalepsy: A condition characterized by inactivity, decreased responsiveness to stimuli, and a tendency to maintain an immobile posture. The limbs tend to remain in whatever position they are placed (waxy flexibility). Catalepsy may be associated with psychotic disorders (e.g., schizophrenia, catatonic), nervous system drug toxicity, and other conditions. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Caudate Nucleus: Elongated gray mass of the neostriatum located adjacent to the lateral ventricle of the brain. [NIH] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Degranulation: The process of losing secretory granules (secretory vesicles). This occurs, for example, in mast cells, basophils, neutrophils, eosinophils, and platelets when secretory products are released from the granules by exocytosis. [NIH] Cell Division: The fission of a cell. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervical Plexus: A network of nerve fibers originating in the upper four cervical spinal cord segments. The cervical plexus distributes cutaneous nerves to parts of the neck, shoulders,
148
Fentanyl
and back of the head, and motor fibers to muscles of the cervical spinal column, infrahyoid muscles, and the diaphragm. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Chlorofluorocarbons: A series of hydrocarbons containing both chlorine and fluorine. These have been used as refrigerants, blowing agents, cleaning fluids, solvents, and as fire extinguishing agents. They have been shown to cause stratospheric ozone depletion and have been banned for many uses. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Cleave: A double-stranded cut in DNA with a restriction endonuclease. [NIH] Clinical Protocols: Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH]
Dictionary 149
Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Compassionate: A process for providing experimental drugs to very sick patients who have no treatment options. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in
150
Fentanyl
addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Conscious Sedation: An alternative to general anesthesia in patients for whom general anesthesia is refused or considered inadvisable. It involves the administering of an antianxiety drug (minor tranquilizer) and an analgesic or local anesthetic. This renders the patient free of anxiety and pain while allowing the patient to remain in verbal contact with the physician or dentist. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continuous infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]
Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains
Dictionary 151
oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Corneum: The superficial layer of the epidermis containing keratinized cells. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticotropin-Releasing Hormone: A neuropeptide released by the hypothalamus that stimulates the release of corticotropin by the anterior pituitary gland. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Craniotomy: An operation in which an opening is made in the skull. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as
152
Fentanyl
cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Defibrillation: The act to arrest the fibrillation of (heart muscle) by applying electric shock across the chest, thus depolarizing the heart cells and allowing normal rhythm to return. [EU] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Demethylation: Process that releases substantial amounts of carbon dioxide in the liver. [NIH]
Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Dexmedetomidine: A selective inhibitor of receptors, adrenergic alpha-2 that has analgesic and sedative properties. Medetomidine is the other racemic form. [NIH]
Dictionary 153
Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diffusivity: Of a reverberant sound field. The degree to which the directions of propagation of waves are random from point to point. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU]
154
Fentanyl
Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diurnal: Occurring during the day. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Dose-dependent: Refers to the effects of treatment with a drug. If the effects change when the dose of the drug is changed, the effects are said to be dose dependent. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Combinations: Single preparations containing two or more active agents, for the purpose of their concurrent administration as a fixed dose mixture. It is differentiated from combination drug therapy in which two or more drugs are administered separately for a combined effect. [NIH] Drug Delivery Systems: Systems of administering drugs through controlled delivery so that an optimum amount reaches the target site. Drug delivery systems encompass the carrier, route, and target. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Drug Toxicity: Manifestations of the adverse effects of drugs administered therapeutically or in the course of diagnostic techniques. It does not include accidental or intentional poisoning for which specific headings are available. [NIH] Duct: A tube through which body fluids pass. [NIH]
Dictionary 155
Ductus Arteriosus: A fetal blood vessel connecting the pulmonary artery with the descending aorta. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]
Emodin: Purgative anthraquinone found in several plants, especially Rhamnus frangula. It was formerly used as a laxative, but is now used mainly as tool in toxicity studies. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotracheal intubation: Insertion of an airtube into the windpipe. [NIH]
156
Fentanyl
Enflurane: An extremely stable inhalation anesthetic that allows rapid adjustments of anesthesia depth with little change in pulse or respiratory rate. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enkephalin: A natural opiate painkiller, in the hypothalamus. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epidural block: An injection of an anesthetic drug into the space between the wall of the spinal canal and the covering of the spinal cord. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]
Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a fungus. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Etomidate: Imidazole derivative anesthetic and hypnotic with little effect on blood gases, ventilation, or the cardiovascular system. It has been proposed as an induction anesthetic. [NIH]
Dictionary 157
Etorphine: A narcotic analgesic morphinan used as a sedative in veterinary practice. [NIH] Euphoria: An exaggerated feeling of physical and emotional well-being not consonant with apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] Excipients: Usually inert substances added to a prescription in order to provide suitable consistency to the dosage form; a binder, matrix, base or diluent in pills, tablets, creams, salves, etc. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excitotoxicity: Excessive exposure to glutamate or related compounds can kill brain neurons, presumably by overstimulating them. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expectorant: 1. Promoting the ejection, by spitting, of mucus or other fluids from the lungs and trachea. 2. An agent that promotes the ejection of mucus or exudate from the lungs, bronchi, and trachea; sometimes extended to all remedies that quiet cough (antitussives). [EU]
Expiration: The act of breathing out, or expelling air from the lungs. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU]
158
Fentanyl
Facial: Of or pertaining to the face. [EU] Fallopian tube: The oviduct, a muscular tube about 10 cm long, lying in the upper border of the broad ligament. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Flatus: Gas passed through the rectum. [NIH] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Flunitrazepam: Benzodiazepine with pharmacologic actions similar to those of diazepam. The United States Government has banned the importation of this drug. Steps are being taken to reclassify this substance as a Schedule 1 drug with no accepted medical use. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen
Dictionary 159
family. It is used in dentistry as flouride to prevent dental caries. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Flupenthixol: This tranquilizer seems to be a dopamine-receptor blocker. It works primarily on the D2 receptors, with some effects on the D1 receptors. Craving in some cocaine addicts becomes manageable but is not eliminated. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Forskolin: Potent activator of the adenylate cyclase system and the biosynthesis of cyclic AMP. From the plant Coleus forskohlii. Has antihypertensive, positive ionotropic, platelet aggregation inhibitory, and smooth muscle relaxant activities; also lowers intraocular pressure and promotes release of hormones from the pituitary gland. [NIH] Functional Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of
160
Fentanyl
heredity. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glucuronides: Glycosides of glucuronic acid formed by the reaction of uridine diphosphate glucuronic acid with certain endogenous and exogenous substances. Their formation is important for the detoxification of drugs, steroid excretion and bilirubin metabolism to a more water-soluble compound that can be eliminated in the urine and bile. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]
Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]
Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Gynaecological: Pertaining to gynaecology. [EU] Haematemesis: The vomiting of blood. [EU]
Dictionary 161
Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Hallucinogen: A hallucination-producing drug, a category of drugs producing this effect. The user of a hallucinogenic drug is almost invariably aware that what he is seeing are hallucinations. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Hepatic: Refers to the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]
Herniorrhaphy: An operation to repair a hernia. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Horny layer: The superficial layer of the epidermis containing keratinized cells. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH]
162
Fentanyl
Hydrocodone: Narcotic analgesic related to codeine, but more potent and more addicting by weight. It is used also as cough suppressant. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogenation: Specific method of reduction in which hydrogen is added to a substance by the direct use of gaseous hydrogen. [NIH] Hydromorphone: An opioid analgesic made from morphine and used mainly as an analgesic. It has a shorter duration of action than morphine. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hyperreflexia: Exaggeration of reflexes. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoventilation: A reduction in the amount of air entering the pulmonary alveoli. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterectomy: Excision of the uterus. [NIH] Hysteroscopy: Endoscopic examination, therapy or surgery of the interior of the uterus.
Dictionary 163
[NIH]
Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileus: Obstruction of the intestines. [EU] Illusion: A false interpretation of a genuine percept. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunogen: A substance that is capable of causing antibody formation. [NIH] Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incidental: 1. Small and relatively unimportant, minor; 2. Accompanying, but not a major part of something; 3. (To something) Liable to occur because of something or in connection with something (said of risks, responsibilities, .) [EU] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Incubation period: The period of time likely to elapse between exposure to the agent of the disease and the onset of clinical symptoms. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indinavir: A potent and specific HIV protease inhibitor that appears to have good oral
164
Fentanyl
bioavailability. [NIH] Indocyanine Green: A tricarbocyanine dye that is used diagnostically in liver function tests and to determine blood volume and cardiac output. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] In-line: A sexually-reproducing population derived from a common parentage. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Instillation: . [EU] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]
Interindividual: Occurring between two or more individuals. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of
Dictionary 165
digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intramuscular injection: IM. Injection into a muscle. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoflurane: A stable, non-explosive inhalation anesthetic, relatively free from significant side effects. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Lactation: The period of the secretion of milk. [EU] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH]
166
Fentanyl
Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Laryngoscopy: Examination, therapy, or surgery of the interior of the larynx performed with a specially designed endoscope. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is laser lithotripsy. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Loperamide: 4-(p-Chlorophenyl)-4-hydroxy-N.N-dimethyl-alpha,alpha-diphenyl-1piperidine butyramide hydrochloride. Synthetic anti-diarrheal agent with a long duration of action; it is not significantly absorbed from the gut, has no effect on the adrenergic system or central nervous system, but may antagonize histamine and interfere with acetylcholine release locally. [NIH] Lubricants: Oily or slippery substances. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU]
Dictionary 167
Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysergic acid: A compound close in chemical structure to LSD-25 but without hallucinogenic effects; one of the direct chemical predecessors of LSD-25. Sometimes LSD-25 is erroneously called by this name. [NIH] Lysergic Acid Diethylamide: Semisynthetic derivative of ergot (Claviceps purpurea). It has complex effects on serotonergic systems including antagonism at some peripheral serotonin receptors, both agonist and antagonist actions at central nervous system serotonin receptors, and possibly effects on serotonin turnover. It is a potent hallucinogen, but the mechanisms of that effect are not well understood. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH]
168
Fentanyl
Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Meperidine: 1-Methyl-4-phenyl-4-piperidinecarboxylic acid ethyl ester. A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of dextroamphetamine. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Microglia: The third type of glial cell, along with astrocytes and oligodendrocytes (which together form the macroglia). Microglia vary in appearance depending on developmental stage, functional state, and anatomical location; subtype terms include ramified, perivascular, ameboid, resting, and activated. Microglia clearly are capable of phagocytosis and play an important role in a wide spectrum of neuropathologies. They have also been suggested to act in several other roles including in secretion (e.g., of cytokines and neural growth factors), in immunological processing (e.g., antigen presentation), and in central nervous system development and remodeling. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH]
Dictionary 169
Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH]
Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Miosis: Pupillary constriction. This may result from congenital absence of the dilatator pupillary muscle, defective sympathetic innervation, or irritation of the conjunctiva or cornea. [NIH] Miotic: 1. Pertaining to, characterized by, or producing miosis : contraction of the pupil. 2. An agent that causes the pupil to contract. 3. Meiotic: characterized by cell division. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modified radical mastectomy: Surgery for breast cancer in which the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles are removed. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]
Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH]
170
Fentanyl
Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]
Mucosa: A mucous membrane, or tunica mucosa. [EU] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naive: Used to describe an individual who has never taken a certain drug or class of drugs (e. g., AZT-naive, antiretroviral-naive), or to refer to an undifferentiated immune system cell. [NIH] Nalbuphine: A narcotic used as a pain medication. It appears to be an agonist at kappa opioid receptors and an antagonist or partial agonist at mu opioid receptors. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has
Dictionary 171
morphine-like actions. [EU] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH]
172
Fentanyl
Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Niacinamide: An important compound functioning as a component of the coenzyme NAD. Its primary significance is in the prevention and/or cure of blacktongue and pellagra. Most animals cannot manufacture this compound in amounts sufficient to prevent nutritional deficiency and it therefore must be supplemented through dietary intake. [NIH] Nicorandil: A derivative of the niacinamide that is structurally combined with an organic nitrate. It is a potassium-channel opener that causes vasodilatation of arterioles and large coronary arteries. Its nitrate-like properties produce venous vasodilation through stimulation of guanylate cyclase. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]
Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitrous Oxide: Nitrogen oxide (N2O). A colorless, odorless gas that is used as an anesthetic and analgesic. High concentrations cause a narcotic effect and may replace oxygen, causing death by asphyxia. It is also used as a food aerosol in the preparation of whipping cream. [NIH]
Nonmalignant: Not cancerous. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the
Dictionary 173
information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus Accumbens: Collection of pleomorphic cells in the caudal part of the anterior horn of the lateral ventricle, in the region of the olfactory tubercle, lying between the head of the caudate nucleus and the anterior perforated substance. It is part of the so-called ventral striatum, a composite structure considered part of the basal ganglia. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Orthostatic: Pertaining to or caused by standing erect. [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Oxycodone: Semisynthetic derivative of codeine that acts as a narcotic analgesic more potent and addicting than codeine. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU]
174
Fentanyl
Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Pain Threshold: Amount of stimulation required before the sensation of pain is experienced. [NIH]
Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papaverine: An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a direct-acting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Patent ductus arteriosus: Abnormal persistence of the opening in the arterial duct that connects the pulmonary artery to the descending aorta; this opening normally closes within 24 hours of birth. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pemoline: A central nervous system stimulant used in fatigue and depressive states and to treat hyperkinetic disorders in children. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH]
Dictionary 175
Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Periventricular Leukomalacia: Rare form of epilepsy. [NIH] Pertussis: An acute, highly contagious infection of the respiratory tract, most frequently affecting young children, usually caused by Bordetella pertussis; a similar illness has been associated with infection by B. parapertussis and B. bronchiseptica. It is characterized by a catarrhal stage, beginning after an incubation period of about two weeks, with slight fever, sneezing, running at the nose, and a dry cough. In a week or two the paroxysmal stage begins, with the characteristic paroxysmal cough, consisting of a deep inspiration, followed by a series of quick, short coughs, continuing until the air is expelled from the lungs; the close of the paroxysm is marked by a long-drawn, shrill, whooping inspiration, due to spasmodic closure of the glottis. This stage lasts three to four weeks, after which the convalescent stage begins, in which paroxysms grow less frequent and less violent, and finally cease. Called also whooping cough. [EU] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacogenetics: A branch of genetics which deals with the genetic components of variability in individual responses to and metabolism (biotransformation) of drugs. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phencyclidine: A hallucinogen formerly used as a veterinary anesthetic, and briefly as a general anesthetic for humans. Phencyclidine is similar to ketamine in structure and in many of its effects. Like ketamine, it can produce a dissociative state. It exerts its pharmacological action through inhibition of NMDA receptors (receptors, N-methyl-Daspartate). As a drug of abuse, it is known as PCP and Angel Dust. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an
176
Fentanyl
expiratory blast of air. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phototransduction: The transducing of light energy to afferent nerve impulses, such as takes place in the retinal rods and cones. After light photons are absorbed by the photopigments, the signal is transmitted to the outer segment membrane by the cyclic GMP second messenger system, where it closes the sodium channels. This channel gating ultimately generates an action potential in the inner retina. [NIH] Phrenic Nerve: The motor nerve of the diaphragm. The phrenic nerve fibers originate in the cervical spinal column (mostly C4) and travel through the cervical plexus to the diaphragm. [NIH]
Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through membranes. It can be applied topically to the conjunctiva. It also can cross the blood-brain barrier and is used when central nervous system effects are desired, as in the treatment of severe anticholinergic toxicity. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pleomorphic: Occurring in various distinct forms. In terms of cells, having variation in the size and shape of cells or their nuclei. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or
Dictionary 177
veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Pollen: The male fertilizing element of flowering plants analogous to sperm in animals. It is released from the anthers as yellow dust, to be carried by insect or other vectors, including wind, to the ovary (stigma) of other flowers to produce the embryo enclosed by the seed. The pollens of many plants are allergenic. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]
Polyethylene Glycols: Alpha-Hydro-omega-hydroxypoly(oxy-1,2-ethanediyls). Additional polymers of ethylene oxide and water and their ethers. They vary in consistency from liquid to solid, depending on the molecular weight, indicated by a number following the name. Used as surfactants in industry, including foods, cosmetics and pharmaceutics; in biomedicine, as dispersing agents, solvents, ointment and suppository bases, vehicles, tablet excipients. Some specific groups are lauromagrogols, nonoxynols, octoxynols and poloxamers. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postoperative Nausea and Vomiting: Emesis and queasiness occurring after anesthesia. [NIH]
Postoperative Period: The period following a surgical operation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU]
178
Fentanyl
Premedication: Preliminary administration of a drug preceding a diagnostic, therapeutic, or surgical procedure. The commonest types of premedication are antibiotics (antibiotic prophylaxis) and anti-anxiety agents. It does not include preanesthetic medication. [NIH] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Propionic Acids: 3-carbon saturated monocarboxylic acids. [NIH] Propofol: A widely used anesthetic. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextroisomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to
Dictionary 179
indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH]
180
Fentanyl
Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]
Psychometric testing: Psychological and mental testing and quantitative analysis of an individual's psychological traits or attitudes or mental processes. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychophysics: The science dealing with the correlation of the physical characteristics of a stimulus, e.g., frequency or intensity, with the response to the stimulus, in order to assess the psychologic factors involved in the relationship. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotomimetic: Psychosis miming. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Alveoli: Small polyhedral outpouchings along the walls of the alveolar sacs, alveolar ducts and terminal bronchioles through the walls of which gas exchange between alveolar air and pulmonary capillary blood takes place. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Pupil: The aperture in the iris through which light passes. [NIH] Pustular: Pertaining to or of the nature of a pustule; consisting of pustules (= a visible collection of pus within or beneath the epidermis). [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU]
Dictionary 181
Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Racemic: Optically inactive but resolvable in the way of all racemic compounds. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radical mastectomy: Surgery for breast cancer in which the breast, chest muscles, and all of the lymph nodes under the arm are removed. For many years, this was the operation most used, but it is used now only when the tumor has spread to the chest muscles. Also called the Halsted radical mastectomy. [NIH] Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Adrenergic: Cell-surface proteins that bind epinephrine and/or norepinephrine with high affinity and trigger intracellular changes. The two major classes of adrenergic receptors, alpha and beta, were originally discriminated based on their cellular actions but now are distinguished by their relative affinity for characteristic synthetic ligands. Adrenergic receptors may also be classified according to the subtypes of G-proteins with which they bind; this scheme does not respect the alpha-beta distinction. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH]
182
Fentanyl
Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retrobulbar: Behind the pons. [EU] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Reverberant: The sound field prevailing in a large enclosure with moderately reflecting surfaces. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH]
Dictionary 183
Ritalin: Drug used to treat hyperactive children. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Salicylic: A tuberculosis drug. [NIH] Salicylic Acids: Derivatives and salts of salicylic acid. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizophrenia, Catatonic: A type of schizophrenia characterized by abnormality of motor behavior which may involve particular forms of stupor, rigidity, excitement or inappropriate posture. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Scopolamine: An alkaloid from Solanaceae, especially Datura metel L. and Scopola carniolica. Scopolamine and its quaternary derivatives act as antimuscarinics like atropine, but may have more central nervous system effects. Among the many uses are as an anesthetic premedication, in urinary incontinence, in motion sickness, as an antispasmodic, and as a mydriatic and cycloplegic. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Secretory Vesicles: Vesicles derived from the golgi apparatus containing material to be released at the cell surface. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH]
184
Fentanyl
Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep Deprivation: The state of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels.
Dictionary 185
[NIH]
Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Acetate: The trihydrate sodium salt of acetic acid, which is used as a source of sodium ions in solutions for dialysis and as a systemic and urinary alkalizer, diuretic, and expectorant. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spasmodic: Of the nature of a spasm. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sphincters: Any annular muscle closing an orifice. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Stabilizer: A device for maintaining constant X-ray tube voltage or current. [NIH] Steady state: Dynamic equilibrium. [EU] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones,
186
Fentanyl
bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Striatum: A higher brain's domain thus called because of its stripes. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Substrate: A substance upon which an enzyme acts. [EU] Succinylcholine: A quaternary skeletal muscle relaxant usually used in the form of its bromide, chloride, or iodide. It is a depolarizing relaxant, acting in about 30 seconds and with a duration of effect averaging three to five minutes. Succinylcholine is used in surgical, anesthetic, and other procedures in which a brief period of muscle relaxation is called for. [NIH]
Sufentanil: An opioid analgesic that is used as an adjunct in anesthesia, in balanced anesthesia, and as a primary anesthetic agent. [NIH] Sumatriptan: A serotonin agonist that acts selectively at 5HT1 receptors. It is used in the treatment of migraines. [NIH] Supplementation: Adding nutrients to the diet. [NIH]
Dictionary 187
Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympatholytics: Drugs that inhibit the actions of the sympathetic nervous system by any mechanism. The most common of these are the adrenergic antagonists and drugs that deplete norepinephrine or reduce the release of transmitters from adrenergic postganglionic terminals. Drugs that act in the central nervous system to reduce sympathetic activity (e.g., centrally acting alpha-2 adrenergic agonists) are included here. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synchrony: The normal physiologic sequencing of atrial and ventricular activation and contraction. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
188
Fentanyl
Systemic: Affecting the entire body. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Tetrahydrocannabinol: A psychoactive compound extracted from the resin of Cannabis sativa (marihuana, hashish). The isomer delta-9-tetrahydrocannabinol (THC) is considered the most active form, producing characteristic mood and perceptual changes associated with this compound. Dronabinol is a synthetic form of delta-9-THC. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thoracic: Having to do with the chest. [NIH] Thoracotomy: Surgical incision into the chest wall. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]
Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Distribution: Accumulation of a drug or chemical substance in various organs (including those not relevant to its pharmacologic or therapeutic action). This distribution depends on the blood flow or perfusion rate of the organ, the ability of the drug to penetrate organ membranes, tissue specificity, protein binding. The distribution is usually expressed as tissue to plasma ratios. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Topical: On the surface of the body. [NIH]
Dictionary 189
Total hysterectomy: Surgery to remove the entire uterus. [NIH] Tourniquet: A device, band or elastic tube applied temporarily to press upon an artery to stop bleeding; a device to compress a blood vessel in order to stop bleeding. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating. [NIH] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral resection: Surgery performed with a special instrument inserted through the urethra. Also called TUR. [NIH] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU]
190
Fentanyl
Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tubercle: A rounded elevation on a bone or other structure. [NIH] Tubocurarine: A neuromuscular blocker and active ingredient in curare; plant based alkaloid of Menispermaceae. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]
Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Uridine Diphosphate: A uracil nucleotide containing a pyrophosphate group esterified to C5 of the sugar moiety. [NIH] Uridine Diphosphate Glucuronic Acid: A nucleoside diphosphate sugar which serves as a source of glucuronic acid for polysaccharide biosynthesis. It may also be epimerized to UDP iduronic acid, which donates iduronic acid to polysaccharides. In animals, UDP glucuronic acid is used for formation of many glucosiduronides with various aglycones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also
Dictionary 191
called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventilator: A breathing machine that is used to treat respiratory failure by promoting ventilation; also called a respirator. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH]
192
Fentanyl
Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenograft: The cells of one species transplanted to another species. [NIH] Xenon: A noble gas with the atomic symbol Xe, atomic number 54, and atomic weight 131.30. It is found in the earth's atmosphere and has been used as an anesthetic. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]
193
INDEX A Abdomen, 137, 145, 148, 160, 164, 165, 166, 174, 175, 186, 188, 191 Abdominal, 26, 34, 35, 39, 44, 53, 57, 59, 78, 137, 145, 153, 174, 175 Abdominal Pain, 53, 137 Abortion, 25, 137 Acetaminophen, 98, 137 Acetic Acids, 112, 137 Acetylcholine, 137, 148, 166, 172 Acrylonitrile, 137, 183 Adaptation, 137, 176 Adenosine, 137, 146, 176, 188 Adenylate Cyclase, 137, 159 Adjuvant, 7, 112, 137, 159 Adrenal Cortex, 137, 151, 178 Adrenal Medulla, 137, 138, 147, 156, 172 Adrenalin, 88, 138 Adrenaline, 34, 38, 64, 138 Adrenergic, 6, 138, 140, 154, 156, 166, 181, 187 Adrenergic Agonists, 138, 187 Adrenergic Antagonists, 138, 187 Adverse Effect, 16, 25, 138, 154, 184 Aerosol, 90, 138, 143, 172 Afferent, 16, 138, 176 Afferent Pathways, 16, 138 Affinity, 95, 138, 142, 181, 185 Agmatine, 4, 76, 138 Agonist, 6, 15, 20, 77, 97, 99, 100, 105, 138, 145, 154, 167, 170, 172, 186 Airway, 30, 33, 36, 40, 42, 57, 138 Albumin, 138, 176 Alertness, 138, 146 Alfentanil, 8, 21, 23, 29, 30, 31, 36, 39, 45, 55, 62, 65, 71, 87, 91, 92, 98, 101, 102, 103, 138 Algorithms, 139, 144 Alimentary, 139, 174 Alkaline, 139, 140, 146 Alkaloid, 139, 142, 145, 146, 149, 169, 172, 174, 183, 188, 190 Allylamine, 139 Aloe, 104, 139 Alpha Particles, 139, 181 Alprostadil, 47, 139 Alternative medicine, 111, 139 Alveoli, 139, 191
Ameliorating, 7, 139 Amine, 88, 93, 139, 161 Amino Acid Sequence, 139, 141, 143, 159 Aminophylline, 70, 139 Ammonia, 139, 140, 187, 190 Amnesia, 81, 140 Amnestic, 140, 169 Amphetamine, 6, 15, 95, 140, 153 Amygdala, 140, 188 Anaesthetic, 23, 32, 56, 97, 105, 140 Analog, 47, 105, 140 Anaphylaxis, 66, 140 Anatomical, 140, 142, 148, 153, 163, 168 Anesthetics, 22, 65, 90, 93, 104, 112, 140, 156 Aneurysm, 140, 191 Animal model, 8, 12, 140 Antagonism, 11, 70, 140, 146, 153, 167, 188 Anti-Anxiety Agents, 140, 178 Antibacterial, 140, 185 Antibiotic, 140, 141, 174, 178, 185 Antibiotic Prophylaxis, 141, 178 Antibodies, 17, 95, 99, 141, 161, 163, 167, 176 Antibody, 138, 141, 149, 152, 156, 161, 163, 164, 167, 169, 181, 185 Anticoagulant, 141, 179 Anticonvulsant, 4, 70, 141 Antidepressant, 10, 141, 159 Antidiuretic, 42, 141 Antigen, 138, 140, 141, 149, 161, 162, 163, 164, 167, 168 Antihypertensive, 141, 159 Anti-inflammatory, 87, 98, 137, 141, 142, 143, 152, 160, 163, 165, 183 Anti-Inflammatory Agents, 141, 142, 165 Antipyretic, 137, 141 Antispasmodic, 141, 173, 183 Antitussive, 141, 173, 178 Anus, 141, 145, 149, 181 Anxiety, 22, 54, 97, 100, 140, 141, 150 Anxiolytic, 141, 169, 173 Aorta, 141, 146, 151, 155, 174, 191 Aphonia, 66, 141 Applicability, 19, 105, 141 Aqueous, 93, 141, 143 Arachidonic Acid, 141, 178 Arginine, 4, 138, 142, 172
194
Fentanyl
Arrestin, 20, 142 Arrhythmia, 142, 191 Arterial, 38, 139, 142, 151, 174, 179 Arteries, 141, 142, 144, 151, 168, 170, 172, 180 Arterioles, 142, 144, 170, 172 Artery, 58, 76, 140, 142, 151, 158, 180, 189 Arthroscopy, 24, 36, 46, 142 Aseptic, 6, 142 Aspartate, 9, 142, 165, 175 Asphyxia, 142, 172 Aspiration, 75, 142 Aspirin, 87, 98, 142 Assay, 14, 142, 163 Astrocytes, 142, 168, 169 Atmospheric Pressure, 142, 162 Atrial, 142, 151, 187, 189 Atrioventricular, 142, 151 Atrium, 142, 146, 151, 189, 191 Atropine, 70, 142, 183 Attenuation, 7, 9, 142 Auditory, 142, 157, 191 Autonomic, 16, 137, 142, 172, 175, 187 Autonomic Nervous System, 142, 175, 187 Axilla, 143, 145 Axillary, 27, 41, 143 B Back Pain, 65, 143 Bacteria, 140, 141, 143, 158, 168, 185, 189, 190 Bactericidal, 143, 156 Basal Ganglia, 143, 173 Base, 5, 14, 90, 93, 143, 152, 157, 159, 165, 188 Basophils, 143, 147, 166 Beclomethasone, 61, 143 Benzene, 143 Benzodiazepines, 15, 112, 143 Beta-Endorphin, 97, 143 Bile, 143, 159, 160, 166, 186 Bilirubin, 138, 143, 160 Bioavailability, 12, 143, 164 Bioavailable, 101, 143 Biochemical, 20, 144, 158, 175, 184 Biopsy, 144, 174 Biotechnology, 22, 23, 107, 111, 121, 144 Biotransformation, 144, 175 Bladder, 28, 144, 163, 166, 171, 179, 182, 190 Blood Coagulation, 144, 146, 188 Blood Flow Velocity, 41, 144 Blood Platelets, 144, 184
Blood pressure, 141, 144, 162, 180, 185 Blood vessel, 144, 146, 147, 148, 150, 151, 155, 157, 165, 174, 184, 186, 188, 189, 191 Blood Volume, 144, 164 Blood-Brain Barrier, 20, 144, 171, 176 Body Fluids, 144, 145, 154, 185 Bolus, 31, 39, 62, 65, 90, 93, 144 Bolus infusion, 144 Bolus injection, 90, 93, 144 Bone Marrow, 143, 144, 151, 167 Bowel, 16, 71, 145, 153, 159, 165, 175, 186 Bowel Movement, 145, 153, 186 Brachial, 27, 41, 145 Brachial Plexus, 27, 41, 145 Brachytherapy, 145, 164, 181 Bradykinin, 145, 172, 176 Branch, 133, 145, 174, 175, 180, 185, 188 Breakdown, 145, 153, 159 Bronchi, 145, 156, 157, 188 Bronchial, 88, 139, 145, 161, 188 Bronchial Spasm, 88, 145 Bronchiseptica, 145, 175 Bronchoconstriction, 47, 48, 145 Bronchus, 145 Buccal, 110, 145 Buprenorphine, 6, 54, 72, 102, 145 Butorphanol, 6, 145 Bypass, 29, 38, 40, 77, 145 C Caesarean section, 31, 39, 45, 46, 52, 55, 145 Caffeine, 44, 112, 145 Calcium, 14, 77, 146, 149, 153, 174, 191 Calcium channel blocker, 77, 146, 191 Cannabidiol, 146 Cannabinoids, 100, 146 Cannabinol, 146 Capping, 14, 146 Capsaicin, 112, 146 Capsules, 92, 146, 154, 159 Carbon Dioxide, 36, 146, 152, 159, 182 Carcinogenic, 143, 146, 164, 186 Cardiac, 24, 26, 28, 32, 47, 59, 62, 139, 146, 151, 156, 164, 166, 169, 170, 185 Cardiac Output, 146, 164 Cardiopulmonary, 29, 30, 33, 146 Cardiopulmonary Bypass, 30, 33, 146 Cardiorespiratory, 146, 169 Cardiovascular, 31, 73, 140, 146, 156, 184 Cardiovascular System, 146, 156 Carrier Proteins, 146, 176 Case report, 28, 45, 52, 72, 146, 147, 148
Index 195
Case series, 147, 148 Catalepsy, 100, 147 Catecholamine, 147, 154 Catheter, 6, 54, 147, 165, 166 Catheterization, 147, 165 Caudal, 26, 31, 34, 44, 147, 162, 173, 177 Caudate Nucleus, 147, 173 Cause of Death, 86, 147 Cell Degranulation, 7, 147 Cell Division, 143, 147, 167, 169, 176, 178 Cell Respiration, 147, 182 Cell Size, 147, 158 Cerebral, 4, 30, 41, 45, 55, 143, 144, 147, 150, 152, 156, 157, 174, 180 Cerebrospinal, 7, 147 Cerebrospinal fluid, 7, 147 Cerebrum, 147 Cervical, 145, 147, 176 Cervical Plexus, 147, 176 Cervix, 137, 147, 148 Chest wall, 42, 72, 148, 169, 188 Chin, 46, 148, 168 Chlorine, 148 Chlorofluorocarbons, 91, 148 Cholinergic, 148, 172 Cisplatin, 148, 173 Cleave, 146, 148 Clinical Protocols, 19, 148 Clinical study, 21, 40, 77, 148 Clinical trial, 3, 19, 26, 43, 67, 81, 82, 121, 148, 150, 151, 154, 179, 181 Cloning, 144, 148 Coagulation, 144, 148, 161, 176, 188 Coca, 148, 149 Cocaine, 4, 8, 11, 14, 15, 76, 95, 148, 149, 159 Codeine, 9, 43, 149, 162, 173 Cofactor, 149, 179, 188 Collagen, 139, 149, 159, 176 Collapse, 140, 145, 149 Colon, 13, 32, 149, 166 Colonoscopy, 33, 149 Compassionate, 49, 149 Complement, 149, 150, 176 Complementary and alternative medicine, 75, 79, 149 Complementary medicine, 75, 150 Compress, 150, 189 Computational Biology, 121, 150 Conception, 137, 150, 158 Cone, 150, 187 Conjugated, 17, 150, 152
Conjunctiva, 150, 164, 169, 176 Conscious Sedation, 27, 72, 97, 150 Consciousness, 27, 36, 37, 138, 140, 150, 152, 153, 180 Constipation, 71, 87, 150, 159 Constriction, 150, 165, 169, 191 Consumption, 12, 150, 173 Continuous infusion, 16, 81, 90, 93, 150 Contraindications, ii, 150 Controlled study, 28, 75, 150 Convulsions, 141, 150, 162 Coordination, 16, 150 Cor, 16, 150, 151 Corneum, 21, 151, 156 Coronary, 24, 30, 33, 40, 62, 67, 76, 77, 151, 168, 170, 172 Coronary Arteriosclerosis, 151, 170 Coronary Artery Bypass, 24, 30, 33, 62, 67, 151 Coronary Thrombosis, 151, 168, 170 Cortex, 151, 157 Cortical, 30, 151, 157, 184 Corticotropin-Releasing Hormone, 16, 151 Cortisol, 17, 33, 138, 151 Cortisone, 151, 152 Craniotomy, 45, 70, 151 Curare, 151, 170, 190 Curative, 151, 188 Cutaneous, 13, 147, 151 Cyclic, 137, 146, 151, 159, 160, 172, 176, 179, 188 Cyclosporine, 10, 151 Cytochrome, 10, 18, 151 Cytokines, 7, 152, 168 Cytotoxic, 146, 152, 173, 181 Cytotoxic chemotherapy, 152, 173 Cytotoxicity, 48, 76, 139, 148, 152 D Deamination, 152, 169, 190 Decarboxylation, 152, 161 Defibrillation, 43, 152 Delirium, 60, 152 Delusions, 152, 180 Demethylation, 10, 152 Density, 20, 76, 152, 158, 173, 177 Dermal, 91, 152 Dermis, 152, 187, 189 Detoxification, 10, 152, 160 Dexamethasone, 16, 152 Dexmedetomidine, 5, 7, 152 Dextroamphetamine, 112, 140, 153, 168 Diagnostic procedure, 85, 111, 153
196
Fentanyl
Diaphragm, 148, 153, 176 Diarrhea, 153, 159 Diffusivity, 88, 153 Digestion, 14, 139, 143, 145, 153, 165, 166, 186 Digestive system, 82, 153 Digestive tract, 153, 184 Dilatation, 137, 140, 153, 178, 191 Dilatation, Pathologic, 153, 191 Dilation, 145, 153, 191 Diltiazem, 35, 153 Dimethyl, 153, 166 Direct, iii, 86, 91, 115, 153, 154, 162, 167, 174, 182, 187 Discrimination, 9, 11, 153 Disinfectant, 153, 156 Disorientation, 152, 153, 154 Disposition, 10, 14, 18, 59, 153 Dissociation, 138, 153 Distal, 151, 154, 179 Diuresis, 146, 154, 188 Diurnal, 17, 154 Dizziness, 154, 191 Dopamine, 15, 140, 149, 153, 154, 159, 169, 172 Dosage Forms, 86, 103, 154 Dose-dependent, 11, 154 Double-blind, 26, 30, 37, 38, 39, 59, 61, 64, 154 Double-blinded, 26, 39, 59, 154 Drive, ii, vi, 4, 69, 154 Drug Combinations, 13, 154 Drug Delivery Systems, 94, 154 Drug Interactions, 9, 18, 19, 62, 116, 154 Drug Tolerance, 154, 188 Drug Toxicity, 4, 147, 154 Duct, 147, 154, 174, 183, 187 Ductus Arteriosus, 155 Dyes, 14, 143, 155, 158, 172 Dyspnea, 52, 65, 155 E Efficacy, 8, 9, 10, 14, 18, 20, 22, 26, 30, 37, 43, 45, 57, 59, 61, 64, 67, 72, 75, 81, 86, 90, 155 Elastic, 155, 189 Elective, 45, 46, 57, 155 Electric shock, 152, 155 Electrolyte, 152, 155, 177, 185 Electromyography, 28, 155 Embryo, 137, 155, 164, 177 Emesis, 58, 155, 177 Emodin, 139, 155
Endocrine System, 155, 171 Endogenous, 4, 12, 13, 138, 143, 154, 155, 160, 179 Endorphins, 155, 172 Endoscope, 155, 166 Endoscopic, 142, 149, 155, 162, 169 Endothelial cell, 21, 39, 144, 155, 188 Endothelium, 155, 172 Endothelium-derived, 155, 172 Endotracheal intubation, 40, 155 Enflurane, 70, 156 Enhancer, 10, 94, 105, 156 Enkephalin, 143, 156 Environmental Health, 120, 122, 156 Enzymatic, 95, 139, 146, 149, 156, 161, 182 Enzyme, 10, 19, 137, 156, 160, 169, 176, 179, 186, 188, 192 Enzyme Inhibitors, 156, 176 Eosinophils, 147, 156, 166 Epidermis, 89, 96, 151, 152, 156, 161, 165, 180 Epidural block, 34, 39, 156 Epinephrine, 36, 38, 39, 138, 154, 156, 172, 181, 190 Epitope, 99, 156 Ergot, 138, 156, 167 Escalation, 76, 156 Esophagus, 153, 156, 175, 186 Estrogen, 156, 178 Ethanol, 12, 156 Ethnic Groups, 14, 156 Etomidate, 32, 62, 64, 92, 156 Etorphine, 20, 157 Euphoria, 15, 157 Evacuation, 150, 157 Evoke, 157, 186 Evoked Potentials, 59, 157 Excipients, 157, 177 Excitation, 157, 158, 172 Excitatory, 5, 157, 160 Excitotoxicity, 4, 157 Exhaustion, 140, 157 Exocytosis, 147, 157 Exogenous, 4, 144, 155, 157, 160, 179 Expectorant, 157, 185 Expiration, 157, 182 External-beam radiation, 157, 181 Extracellular, 5, 142, 157, 168, 185 Extracellular Space, 157, 168 Extracorporeal, 36, 157 Extraction, 14, 55, 62, 157 Extrapyramidal, 154, 157
Index 197
Extremity, 145, 157 Exudate, 157, 173 F Facial, 28, 158 Fallopian tube, 158, 190 Family Planning, 121, 158 Fat, 141, 144, 150, 158, 166, 182, 183 Fatigue, 158, 161, 174 Fatty acids, 138, 158, 178 Feces, 150, 158, 186 Femoral, 146, 158 Femoral Artery, 146, 158 Fetus, 137, 158, 190 Fibrillation, 152, 158 Fibrinogen, 158, 176, 188 Flatus, 158, 159 Flow Cytometry, 17, 158 Flunitrazepam, 14, 158 Fluorescence, 158 Fluorescent Dyes, 158 Fluorine, 148, 158 Fluoxetine, 15, 159 Flupenthixol, 15, 159 Fold, 101, 105, 159 Forskolin, 47, 159 Functional Disorders, 16, 159 G Gallbladder, 137, 153, 159, 166 Gamma Rays, 159, 181 Ganglia, 137, 159, 171, 175, 187 Gas, 110, 140, 146, 148, 158, 159, 162, 172, 180, 191, 192 Gas exchange, 159, 180, 191 Gastric, 43, 154, 159, 161 Gastrin, 159, 161 Gastrointestinal, 13, 33, 88, 92, 145, 156, 159, 184, 186 Gastrointestinal tract, 88, 92, 156, 159, 184 Gelatin, 159, 160, 187 Gels, 71, 159 Gene, 107, 144, 159, 176 Genetic Code, 159, 173 Genetics, 159, 175 Gestation, 16, 160 Gland, 137, 151, 160, 167, 174, 176, 179, 183, 186, 187 Glottis, 160, 175 Glucocorticoid, 143, 152, 160 Glucuronic Acid, 160, 190 Glucuronides, 22, 160 Glutamate, 4, 157, 160 Glutamic Acid, 160, 172
Glycine, 139, 160, 172 Glycoprotein, 10, 20, 45, 158, 160, 188 Governing Board, 160, 177 Graft, 24, 30, 33, 62, 160 Grafting, 67, 151, 160, 163 Granuloma, 6, 160 Gravis, 160, 171 Groin, 160, 164 Growth, 14, 73, 140, 160, 167, 168, 176, 190 Guanylate Cyclase, 160, 172 Gynaecological, 59, 160 H Haematemesis, 155, 160 Haemorrhage, 137, 161 Half-Life, 88, 161 Hallucinogen, 161, 167, 175 Haptens, 138, 161 Headache, 146, 161, 162, 164 Heart failure, 43, 161 Heme, 143, 151, 161 Hemorrhage, 16, 161, 186 Hemostasis, 161, 184 Hepatic, 10, 89, 96, 138, 152, 161, 169 Heredity, 159, 160, 161 Hernia, 161 Herniorrhaphy, 50, 161 Heterogeneity, 138, 161 Histamine, 88, 161, 166 Histidine, 161 Homologous, 161, 187 Hormone, 42, 73, 88, 138, 143, 151, 156, 159, 161, 174, 178 Horny layer, 156, 161 Hospice, 29, 161 Hydrocodone, 5, 162 Hydrogel, 89, 96, 162 Hydrogen, 139, 143, 162, 169, 172, 173, 179 Hydrogenation, 143, 162 Hydromorphone, 7, 21, 63, 71, 162 Hydrophilic, 162 Hydroxyproline, 139, 149, 162 Hyperbaric, 44, 46, 162 Hyperbaric oxygen, 162 Hyperreflexia, 100, 162 Hypersensitivity, 19, 140, 162 Hypertrophy, 151, 162, 189 Hypnotic, 77, 156, 162, 169 Hypoglycaemia, 152, 162 Hypotension, 88, 150, 162 Hypothalamic, 12, 16, 162 Hypothalamus, 143, 151, 156, 162, 176 Hypothermia, 100, 162
198
Fentanyl
Hypoventilation, 105, 162 Hypoxia, 152, 162 Hysterectomy, 78, 162 Hysteroscopy, 32, 162 I Ibuprofen, 87, 98, 163 Id, 73, 78, 126, 132, 134, 163 Ileus, 54, 163 Illusion, 163, 191 Immune function, 17, 163 Immune response, 12, 137, 141, 151, 161, 163, 186, 191 Immune system, 17, 163, 167, 170, 190, 192 Immunity, 12, 163 Immunoassay, 39, 95, 163 Immunogen, 99, 163 Immunoglobulins, 163, 176 Immunologic, 163, 181 Immunology, 137, 138, 158, 163 Impairment, 6, 102, 152, 163, 168, 180 Implant radiation, 163, 164, 181 Implantation, 87, 98, 150, 163 In vitro, 13, 18, 19, 21, 44, 64, 163 In vivo, 7, 10, 13, 18, 19, 20, 21, 163, 168 Incidental, 110, 163 Incision, 40, 56, 145, 163, 165, 179, 188 Incontinence, 163, 183 Incubation, 163, 175 Incubation period, 163, 175 Indicative, 107, 163, 174, 191 Indinavir, 10, 163 Indocyanine Green, 56, 164 Induction, 4, 7, 10, 28, 30, 32, 33, 35, 36, 41, 50, 56, 62, 64, 66, 75, 76, 78, 100, 156, 164, 165, 178 Infarction, 164 Infection, 12, 17, 92, 142, 152, 163, 164, 167, 174, 175, 186, 190, 192 Inflammation, 138, 139, 141, 142, 157, 164, 177, 182, 190 Influenza, 12, 164 Inguinal, 50, 164 Inhalation, 99, 138, 156, 164, 165, 177 Initiation, 30, 164 In-line, 93, 164 Innervation, 145, 164, 169 Inotropic, 154, 164 Instillation, 93, 164 Intensive Care, 11, 15, 34, 43, 55, 70, 81, 164 Interindividual, 18, 164 Intermittent, 23, 33, 76, 164
Internal radiation, 164, 181 Intestinal, 10, 18, 164 Intestine, 18, 145, 164, 166 Intoxication, 4, 12, 152, 165, 192 Intracellular, 20, 146, 164, 165, 172, 177, 179, 181 Intramuscular, 11, 88, 165, 174 Intramuscular injection, 11, 165 Intraocular, 35, 159, 165 Intraocular pressure, 35, 159, 165 Intrinsic, 20, 138, 165 Intubation, 30, 31, 35, 41, 78, 147, 165 Invasive, 15, 97, 163, 165 Involuntary, 158, 165, 170, 182, 185 Ions, 143, 153, 155, 162, 165, 169, 185 Ischemia, 4, 165 Isoflurane, 40, 43, 44, 45, 52, 58, 63, 165 J Joint, 110, 142, 165 K Kb, 120, 165 Keratin, 165, 183 Ketamine, 25, 27, 32, 48, 54, 58, 63, 64, 78, 95, 165, 175 Ketorolac, 23, 36, 165 Kinetics, 7, 10, 165 L Laceration, 22, 26, 165 Lactation, 165, 174, 178 Laparoscopy, 23, 26, 58, 165 Large Intestine, 153, 165, 166, 181, 182, 184 Laryngeal, 30, 33, 40, 57, 59, 166 Laryngoscopy, 40, 78, 166 Larynx, 141, 160, 166, 191 Leucine, 143, 166 Leukocytes, 143, 144, 152, 156, 166, 172 Library Services, 132, 166 Lidocaine, 23, 24, 36, 38, 39, 49, 51, 95, 166 Ligaments, 151, 166 Ligation, 49, 166 Linkage, 146, 166 Lipid, 166, 169 Lithotripsy, 23, 36, 166 Liver, 18, 92, 137, 138, 141, 143, 152, 153, 158, 159, 160, 161, 164, 166, 169, 190 Localized, 164, 166, 169, 176, 190 Locomotion, 166, 176 Locomotor, 100, 166 Loperamide, 45, 166 Lubricants, 90, 166 Lumbar, 38, 51, 143, 166 Lutein Cells, 167, 178
Index 199
Lymph, 143, 147, 155, 167, 169, 181 Lymph node, 143, 147, 167, 169, 181 Lymphatic, 155, 164, 167, 176 Lymphocyte, 17, 141, 167 Lymphoid, 141, 167 Lysergic acid, 39, 95, 167 Lysergic Acid Diethylamide, 39, 167 M Malignant, 6, 167, 181 Mammary, 151, 167 Manic, 167, 180 Manic-depressive psychosis, 167, 180 Mechanical ventilation, 22, 45, 167 Mediate, 15, 20, 154, 167 Mediator, 167, 184 Medical Staff, 154, 167 Medicament, 167, 187 MEDLINE, 121, 167 Meiosis, 167, 187 Membrane, 86, 142, 149, 150, 153, 157, 166, 167, 168, 170, 171, 176, 189 Memory, 4, 100, 140, 152, 168 Meninges, 147, 168 Mental, iv, 3, 83, 120, 122, 148, 152, 153, 158, 168, 180, 183 Mental Disorders, 83, 168, 180 Mental Health, iv, 3, 83, 120, 122, 168, 180 Meperidine, 6, 46, 168 Mercury, 158, 168 Mesolimbic, 15, 168 Metabolite, 95, 144, 153, 168 Methionine, 143, 153, 168 Methylphenidate, 6, 95, 168 MI, 47, 135, 168 Microbe, 168, 189 Microdialysis, 5, 168 Microglia, 142, 168, 169 Microorganism, 149, 168, 192 Migration, 89, 169 Miosis, 169 Miotic, 10, 169 Modeling, 10, 169 Modification, 5, 104, 139, 169, 180 Modified radical mastectomy, 32, 169 Modulator, 13, 169 Molecular, 20, 52, 95, 121, 123, 144, 150, 158, 169, 177, 178, 181, 183, 187, 189 Molecular Structure, 169, 189 Molecule, 95, 105, 141, 143, 149, 153, 155, 156, 157, 169, 173, 181 Monoamine, 5, 140, 153, 169 Monoamine Oxidase, 140, 153, 169
Monoclonal, 169, 181 Mononuclear, 12, 160, 169 Monotherapy, 81, 169 Mood Disorders, 102, 169 Motility, 13, 88, 159, 170, 184 Motion Sickness, 170, 171, 183 Motor nerve, 170, 176 Mucosa, 86, 89, 96, 170, 178 Muscle relaxant, 23, 77, 140, 170, 171, 186 Muscle Relaxation, 170, 186 Muscle tension, 170 Musculoskeletal System, 170, 173 Myalgia, 164, 170 Myasthenia, 170, 171 Mydriatic, 153, 170, 183 Myocardial infarction, 151, 168, 170 Myocardial Ischemia, 44, 170 Myocardium, 168, 170 N Naive, 49, 67, 170 Nalbuphine, 6, 31, 51, 70, 71, 72, 170 Naloxone, 7, 13, 16, 71, 108, 143, 170 Naltrexone, 9, 11, 12, 13, 15, 86, 170 Narcolepsy, 153, 168, 170 Narcosis, 170 Narcotic, 86, 90, 91, 97, 116, 145, 157, 158, 162, 168, 169, 170, 172, 173, 178, 189 Nasal Mucosa, 164, 171 Nausea, 58, 88, 97, 108, 154, 171, 173 NCI, 1, 82, 119, 171 Need, 4, 7, 9, 16, 60, 88, 94, 101, 105, 108, 112, 127, 171, 188 Neonatal, 15, 53, 70, 171 Neostigmine, 51, 171 Nerve, 41, 138, 140, 145, 147, 148, 159, 164, 167, 169, 170, 171, 176, 178, 182, 183, 186, 189, 191 Nerve Fibers, 145, 147, 171, 176 Nervous System, 4, 13, 57, 99, 137, 138, 140, 143, 146, 147, 149, 153, 157, 159, 160, 161, 166, 167, 168, 169, 171, 174, 175, 176, 177, 183, 184, 187, 188 Networks, 7, 17, 171 Neural, 138, 168, 169, 171 Neuroendocrine, 12, 16, 171 Neurogenic, 171, 190 Neuroleptic, 171, 173 Neurologic, 15, 140, 171 Neuromuscular, 52, 137, 171, 190 Neurons, 149, 157, 159, 170, 171, 172, 187 Neuropeptide, 151, 171 Neurosurgery, 57, 71, 171
200
Fentanyl
Neurotransmitter, 5, 13, 137, 139, 145, 154, 160, 161, 172, 186, 187 Neutrons, 139, 172, 181 Neutrophils, 147, 166, 172 Niacinamide, 172 Nicorandil, 48, 172 Nicotine, 14, 95, 172 Nitric Oxide, 4, 9, 172 Nitrogen, 139, 172, 190 Nitrous Oxide, 32, 45, 52, 77, 172 Nonmalignant, 55, 110, 172 Norepinephrine, 15, 138, 154, 172, 181, 187 Nucleic acid, 95, 159, 172 Nucleus, 5, 143, 151, 156, 159, 167, 169, 172, 173, 178, 179, 188 Nucleus Accumbens, 5, 173 Nulliparous, 65, 173 O Ointments, 154, 173 Ondansetron, 53, 57, 173 Opacity, 152, 173 Opiate, 18, 28, 87, 88, 97, 100, 143, 156, 169, 170, 173 Opium, 87, 95, 98, 100, 101, 169, 173, 174 Orthopaedic, 56, 70, 71, 173 Orthostatic, 88, 173 Osteoporosis, 65, 173 Outpatient, 5, 18, 24, 33, 36, 46, 54, 58, 71, 105, 173 Ovaries, 173, 190 Overdose, 53, 173 Ovum, 160, 173, 178 Oxidation, 144, 151, 173 Oxycodone, 5, 9, 10, 24, 41, 55, 95, 173 Oxygen Consumption, 173, 182 Oxygenation, 30, 173 Oxygenator, 146, 174 Oxytocin, 35, 174 P Paediatric, 24, 26, 28, 31, 44, 52, 56, 66, 174 Pain Threshold, 16, 174 Palliative, 10, 25, 52, 53, 61, 62, 63, 65, 110, 174, 188 Pancreas, 137, 153, 174 Papaverine, 173, 174 Parenteral, 18, 86, 97, 174 Paroxysmal, 174, 175, 192 Parturition, 174, 178 Patch, 21, 22, 29, 35, 53, 57, 58, 91, 93, 101, 103, 104, 109, 174, 189 Patent ductus arteriosus, 49, 174 Pathologic, 102, 144, 151, 162, 174, 191
Pelvis, 137, 166, 173, 174, 190 Pemoline, 6, 174 Penicillin, 140, 174 Peptide, 13, 139, 143, 165, 174, 179 Perception, 52, 78, 150, 174, 183 Percutaneous, 71, 92, 93, 166, 174 Perfusion, 162, 174, 188 Perioperative, 32, 44, 57, 76, 175 Peripheral blood, 139, 175 Peripheral Nervous System, 172, 175, 186 Peritoneal, 17, 175 Peritoneum, 175 Periventricular Leukomalacia, 16, 175 Pertussis, 100, 175, 192 Pharmaceutical Solutions, 154, 175 Pharmacodynamics, 18, 59, 62, 175 Pharmacogenetics, 18, 175 Pharmacokinetic, 10, 21, 25, 57, 59, 77, 90, 175 Pharmacologic, 18, 19, 22, 139, 140, 158, 161, 175, 188, 189, 190 Pharynx, 164, 175, 191 Phencyclidine, 95, 175 Phenyl, 100, 168, 175 Phonation, 141, 175 Phosphorus, 146, 176 Phosphorylated, 142, 176 Phototransduction, 142, 176 Phrenic Nerve, 73, 176 Physiologic, 138, 161, 176, 178, 181, 187 Physostigmine, 171, 176 Pilot study, 25, 33, 63, 176 Pituitary Gland, 151, 159, 176 Plants, 139, 142, 146, 149, 155, 172, 176, 177, 189 Plasma, 10, 12, 17, 28, 34, 41, 43, 56, 77, 88, 97, 138, 141, 144, 158, 159, 161, 176, 188 Plasma cells, 141, 176 Plasma protein, 88, 138, 176 Plasticity, 4, 15, 176 Platelet Aggregation, 139, 159, 172, 176 Platelets, 147, 172, 176, 188 Pleomorphic, 173, 176 Plexus, 145, 147, 176 Pneumonia, 150, 177 Poisoning, 152, 154, 156, 165, 168, 171, 177 Pollen, 138, 177 Polyethylene, 91, 177, 187 Polyethylene Glycols, 91, 177, 187 Polymers, 177, 179, 186 Pons, 177, 182 Posterior, 143, 174, 177
Index 201
Postmenopausal, 173, 177 Postoperative Nausea and Vomiting, 44, 177 Postoperative Period, 34, 177 Potassium, 172, 177 Practice Guidelines, 122, 177 Precursor, 141, 154, 155, 156, 172, 177, 190 Premedication, 24, 53, 100, 178, 183 Preoperative, 23, 26, 43, 57, 178 Presynaptic, 172, 178, 187 Prevalence, 11, 178 Probe, 10, 18, 168, 178 Procaine, 95, 166, 178 Progesterone, 178, 185 Progression, 140, 178 Progressive, 11, 154, 156, 160, 178, 182 Projection, 172, 178 Prolactin, 28, 178 Prophase, 178, 187 Propionic Acids, 112, 178 Proportional, 7, 178 Propoxyphene, 5, 178 Prospective study, 45, 178 Prostaglandin, 47, 178 Prostaglandins A, 179 Prostate, 179, 189 Prostatectomy, 50, 179 Protease, 163, 179 Protein Binding, 20, 179, 188 Protein C, 9, 138, 139, 165, 179, 190 Protein S, 107, 144, 159, 179 Proteins, 20, 139, 141, 146, 149, 152, 165, 169, 172, 174, 176, 177, 179, 181, 184 Protocol, 48, 179 Protons, 139, 162, 179, 181 Proximal, 6, 154, 178, 179 Pruritus, 53, 57, 179 Psychiatric, 5, 168, 180, 184 Psychiatry, 8, 28, 180, 186, 191 Psychic, 168, 180, 184 Psychoactive, 86, 180, 188, 192 Psychogenic, 141, 180, 190 Psychometric testing, 16, 180 Psychomotor, 6, 8, 152, 171, 180 Psychophysics, 19, 180 Psychosis, 27, 180 Psychotomimetic, 140, 153, 180 Public Health, 7, 9, 122, 180 Public Policy, 121, 180 Pulmonary, 21, 39, 58, 144, 148, 150, 151, 155, 162, 174, 180, 191 Pulmonary Alveoli, 162, 180
Pulmonary Artery, 144, 155, 174, 180, 191 Pulmonary hypertension, 151, 180 Pulse, 45, 156, 180 Pupil, 153, 169, 170, 180 Pustular, 37, 180 Q Quality of Life, 21, 102, 180 Quaternary, 180, 183, 186 R Race, 152, 169, 181 Racemic, 152, 181 Radiation, 110, 157, 158, 159, 162, 164, 181, 192 Radiation therapy, 110, 157, 162, 164, 181 Radical mastectomy, 181 Radioactive, 161, 162, 163, 164, 181 Radiolabeled, 181 Radiological, 174, 181 Radiotherapy, 145, 181 Randomized, 8, 15, 22, 23, 25, 26, 28, 30, 37, 38, 39, 45, 46, 47, 50, 59, 61, 62, 64, 81, 155, 181 Reality Testing, 180, 181 Receptors, Adrenergic, 152, 181 Receptors, Serotonin, 181, 184 Recombinant, 20, 181 Rectal, 86, 112, 181, 187 Rectum, 141, 145, 149, 153, 158, 159, 163, 166, 179, 181, 182, 187 Refer, 1, 145, 149, 154, 155, 166, 170, 171, 172, 180, 182, 189 Reflex, 88, 182 Refraction, 182, 185 Regimen, 81, 148, 155, 182 Regurgitation, 75, 182 Relaxant, 159, 174, 182, 186 Renal failure, 152, 182 Respiration, 71, 81, 146, 151, 182 Respirator, 167, 182, 191 Respiratory Physiology, 182, 191 Response rate, 11, 100, 182 Retinal, 142, 150, 176, 182 Retrobulbar, 36, 182 Retropubic, 179, 182 Reverberant, 153, 182 Rheumatism, 163, 182 Rhodopsin, 142, 182 Rigidity, 42, 43, 72, 176, 182, 183 Risk factor, 11, 178, 182 Ritalin, 95, 183 Rubber, 92, 137, 183
202
Fentanyl
S Salicylate, 183 Salicylic, 183 Salicylic Acids, 183 Salivary, 153, 183 Salivary glands, 153, 183 Saphenous, 64, 151, 183 Saphenous Vein, 64, 151, 183 Schizoid, 183, 192 Schizophrenia, 147, 183, 192 Schizophrenia, Catatonic, 147, 183 Schizotypal Personality Disorder, 183, 192 Scopolamine, 95, 108, 183 Screening, 7, 95, 148, 183 Sebaceous, 152, 183 Sebaceous gland, 152, 183 Sebum, 14, 183 Secretion, 35, 42, 161, 165, 168, 183 Secretory, 73, 147, 183, 187 Secretory Vesicles, 147, 183 Sedative, 61, 81, 100, 149, 152, 157, 169, 183 Segmental, 51, 183 Segmentation, 183, 184 Seizures, 152, 174, 184 Senile, 173, 184 Sensibility, 140, 184 Sensor, 95, 96, 184 Septic, 142, 184 Sequencing, 184, 187 Serologic, 163, 184 Serotonin, 15, 61, 159, 167, 169, 172, 173, 181, 184, 186, 190 Serum, 14, 90, 138, 149, 184 Shock, 23, 36, 140, 166, 184, 189 Side effect, 6, 10, 14, 18, 26, 36, 72, 87, 92, 105, 112, 115, 138, 165, 184, 189 Signs and Symptoms, 11, 184 Skeletal, 151, 184, 186 Skeleton, 165, 178, 184 Skull, 151, 184, 188 Sleep Deprivation, 28, 184 Small intestine, 71, 161, 165, 184 Smooth muscle, 13, 88, 139, 145, 146, 159, 161, 169, 174, 184, 186 Sneezing, 175, 185 Social Environment, 180, 185 Sodium, 5, 7, 14, 61, 92, 176, 185, 187 Sodium Acetate, 92, 185 Solvent, 90, 105, 143, 156, 175, 185 Soma, 185 Somatic, 16, 56, 167, 175, 185, 191
Spasmodic, 145, 175, 185 Specialist, 127, 153, 185 Species, 13, 146, 151, 156, 167, 169, 181, 185, 186, 191, 192 Specificity, 95, 138, 185, 188 Spectrum, 103, 168, 185 Sperm, 138, 177, 185 Sphincters, 88, 185 Spinal cord, 4, 97, 142, 145, 147, 156, 168, 171, 175, 182, 185, 187 Spinous, 156, 185 Stabilizer, 7, 185 Steady state, 90, 103, 185 Sterile, 142, 185 Steroid, 151, 160, 185 Stimulant, 15, 140, 146, 153, 161, 168, 174, 186 Stimulus, 5, 9, 11, 16, 154, 157, 164, 180, 182, 186, 188 Stomach, 137, 153, 156, 159, 161, 171, 175, 184, 186 Stool, 149, 163, 166, 186 Stress, 12, 14, 15, 16, 28, 42, 62, 77, 143, 147, 151, 159, 171, 183, 186, 190 Striatum, 173, 186 Stroke, 83, 120, 146, 186 Stupor, 170, 183, 186 Styrene, 183, 186 Subacute, 19, 164, 186 Subarachnoid, 26, 47, 66, 161, 186 Subclinical, 164, 184, 186 Subcutaneous, 89, 96, 101, 174, 186 Subspecies, 185, 186 Substance P, 99, 168, 183, 186 Substrate, 104, 156, 186 Succinylcholine, 35, 186 Sufentanil, 24, 32, 36, 37, 41, 45, 46, 51, 54, 55, 78, 87, 89, 90, 91, 92, 96, 98, 101, 102, 103, 186 Sumatriptan, 112, 186 Supplementation, 41, 47, 78, 138, 186 Suppositories, 112, 159, 187 Suppository, 177, 187 Suppression, 12, 187 Sweat, 14, 152, 162, 187 Sweat Glands, 152, 187 Sympathetic Nervous System, 12, 143, 171, 187 Sympatholytics, 112, 187 Sympathomimetic, 140, 153, 154, 156, 172, 187 Synapse, 138, 178, 187, 189
Index 203
Synapsis, 187 Synaptic, 4, 172, 187 Synaptic Transmission, 172, 187 Synchrony, 17, 187 Synergistic, 178, 187 Systemic, 12, 14, 22, 58, 87, 116, 140, 141, 144, 152, 156, 164, 181, 185, 188, 189 T Temporal, 51, 140, 188 Teratogenic, 153, 188 Tetrahydrocannabinol, 146, 188 Thalamic, 71, 188 Theophylline, 139, 188 Therapeutics, 21, 33, 77, 116, 169, 188 Thermal, 21, 98, 153, 172, 188 Thoracic, 30, 38, 39, 43, 64, 143, 145, 153, 188, 192 Thoracotomy, 31, 43, 188 Thorax, 137, 166, 188, 191 Threshold, 43, 188 Thrombin, 158, 176, 179, 188 Thrombomodulin, 179, 188 Thrombosis, 179, 186, 188 Thrombus, 151, 164, 170, 176, 188 Tissue Distribution, 35, 188 Tolerance, 4, 9, 11, 20, 22, 61, 87, 88, 145, 188 Topical, 22, 54, 86, 112, 156, 188 Total hysterectomy, 32, 189 Tourniquet, 46, 189 Toxic, iv, 142, 143, 151, 152, 157, 163, 172, 186, 189 Toxicity, 53, 90, 154, 155, 168, 176, 189 Toxicology, 5, 28, 35, 108, 122, 189 Toxin, 100, 188, 189 Tramadol, 5, 57, 189 Transcutaneous, 75, 189 Transfection, 144, 189 Translating, 7, 18, 189 Translation, 139, 189 Translational, 19, 189 Transmitter, 137, 142, 154, 167, 172, 189 Transurethral, 50, 179, 189 Transurethral resection, 179, 189 Transurethral Resection of Prostate, 179, 189 Trauma, 4, 70, 152, 161, 189 Treatment Failure, 18, 189 Trees, 183, 189 Tricuspid Atresia, 151, 189 Tricyclic, 112, 189 Tryptophan, 149, 184, 190
Tubal ligation, 23, 190 Tubercle, 173, 190 Tubocurarine, 171, 190 Tunica, 170, 190 Tyrosine, 154, 190 U Unconscious, 140, 163, 190 Urea, 14, 187, 190 Ureter, 166, 190 Urethra, 179, 189, 190 Uridine Diphosphate, 160, 190 Uridine Diphosphate Glucuronic Acid, 160, 190 Urinary, 88, 163, 179, 182, 183, 185, 190 Urinary Retention, 88, 190 Urinate, 190 Urine, 14, 28, 141, 144, 154, 160, 163, 190 Urticaria, 140, 190 Uterine Contraction, 137, 174, 190 Uterus, 137, 147, 148, 162, 173, 178, 189, 190 Uveitis, 142, 190 V Vaccine, 137, 179, 190 Vagal, 88, 190 Vagina, 148, 190, 191 Vaginal, 86, 187, 191 Vagus Nerve, 190, 191 Vascular, 24, 31, 62, 64, 139, 140, 144, 152, 155, 164, 172, 188, 190, 191 Vasoconstriction, 156, 191 Vasodilatation, 172, 191 Vasodilation, 88, 172, 174, 191 Vasodilator, 139, 145, 154, 161, 174, 191 Vein, 140, 165, 183, 191 Venous, 66, 172, 179, 189, 191 Ventilation, 36, 72, 81, 156, 191 Ventilator, 167, 182, 191 Ventral, 162, 173, 177, 191 Ventricle, 140, 142, 147, 151, 162, 173, 180, 189, 191 Ventricular, 151, 187, 189, 191 Verapamil, 20, 191 Vertebrae, 185, 191 Vertebral, 65, 191 Vertigo, 108, 191 Veterinary Medicine, 70, 104, 121, 191 Viral, 12, 17, 164, 191 Virulence, 189, 191 Virus, 12, 156, 191 Visceral, 13, 16, 143, 175, 191, 192 Vitro, 18, 19, 21, 192
204
Fentanyl
Vivo, 7, 13, 18, 19, 20, 21, 192 W Wakefulness, 152, 192 Weight Gain, 16, 192 White blood cell, 141, 166, 167, 176, 192 Whooping Cough, 175, 192 Windpipe, 145, 155, 175, 192
Withdrawal, 9, 11, 12, 52, 88, 152, 168, 192 X Xenograft, 140, 192 Xenon, 56, 192 X-ray, 158, 159, 181, 185, 192 Z Zymogen, 179, 192
