Programas de monitoreo de medicamentos de prescripción en los Estados Unidos de América / Prescription drug monitoring programs in the United States of America

Desde finales de la década de los años noventa, el número de muertes por sobredosis que involucran analgésicos opioides se ha cuadriplicado en los Estados Unidos de América (de 4 030 muertes en 1999 a 16 651 en 2010). Los objetivos de este artículo son proporcionar una visión general del problema de sobredosis de medicamentos de prescripción en los Estados Unidos y discutir las acciones que podrían ayudar a reducir el problema, abordando en forma directa las características de los Programas de monitoreo de medicamentos de prescripción (PDMP). Estos programas están compuestos de bases de datos a nivel estatal que vigilan las sustancias controladas. La información recopilada en las bases de datos está a disposición de las personas autorizadas por el Estado (por ejemplo, los médicos, los farmacéuticos y otros proveedores de cuidado médico) y debe ser utilizada solo con propósitos profesionales. Los proveedores pueden utilizar dicha información para evitar la interacción con otros medicamentos, la duplicación terapéutica o la identificación de conductas de búsqueda de drogas. Las agencias del orden público pueden utilizar estos programas para identificar patrones de prescripción inadecuada, dispensación o desviación.

Since the late 1990s, the number of opioid analgesic overdose deaths has quadrupled in the United States of America (from 4 030 deaths in 1999 to 16 651 in 2010). The objectives of this article are to provide an overview of the problem of prescription drug overdose in the United States and to discuss actions that could help reduce the problem, with particular attention to the characteristics of prescription drug monitoring programs (PDMPs). These programs consist of state-level databases that monitor controlled substances. The information compiled in the databases is at the disposal of authorized persons (e.g., physicians, pharmacists, and other health-care providers) and may be used only for professional purposes. Suppliers can use such information to prevent interaction with other drugs or therapeutic duplication, or to identify drug-search behavior. Law enforcement agencies can use these programs to identify improper drug prescription or dispensing patterns, or drug diversion.

The expression of GABA(A) receptor alpha1 and GABA(B) receptor 1 in medulla oblongata solitary nucleus and ambiguous nucleus in the cases of tramadol intoxication / 法医学杂志

OBJECTIVE@#To observe the expression of GABA(A) receptor alpha1 (GABA(A)alpha1) and GABA(B) receptor 1 (GABA(B)1) in human medulla oblongata solitary nucleus and ambiguous nucleus due to tramadol-induced death.@*METHODS@#GABA(A)alpha1 and GABA(B)1 were detected by immunohistochemical SP method in tramadol-induced death group and control group. All results were evaluated by images analysis system.@*RESULTS@#Low expression of GABA(A)alpha1 and GABA(B)1 were detected in solitary nucleus and ambiguous nucleus in the control brain tissue. In cases of tramadol-induced death, the expression of GABA(A)alpha1 and GABA(B)1 significantly increased.@*CONCLUSION@#The mechanism of tramadol intoxication death could be caused by respiratory depression induced by over-expression of GABA(A)alpha1 and GABA(B)1 in medulla oblongata solitary nucleus and ambiguous nucleus.

Tramadol intoxication and its toxicological effect / 法医学杂志

Tramadol is a centrally acting analgesic with a dual mode of action. Its analgesic efficacy is attributed to its partial affinity for the mu-opiate receptor and its inhibition of norepinephrine and serotonin reuptake. Acting in a synergistic manner and being more efficacious, tramadol is used worldwide for the treatment of moderate to severe acute or chronic pain. Abuse and dependence of tramadol as well as tramadol-related deaths have been increasingly reported, either ingested alone or taken in combination with other potentially interacting drugs. The possible toxic effect of tramadol was reviewed from aspects of its analgesic mechanisms, adverse effect, dependence, and abuse.

Dextromethorphan abuse in Thai adolescents: A report of two cases and review of literature.

INTRODUCTION: Dextromethorphan is an opiod-derived, easily available cough remedy that, when used in large quantities, can have stimulatory effects which mimic that of amphetamine and other psychedelic drugs. Due to its easy availability, dextromethorphan is gaining widespread popularity as a recreational drug among Thai youths. Symptoms of overdose are directly related to its pharmacodynamic and pharmacokinetic properties. Dextromethorphan is metabolized by cytochrome p450 2D6, an isoenzyme that exhibit polymorphism in Asians. The drug is also a serotonin-reuptake inhibitor and has significant interactions with other drugs that exert their effects through the serotonin pathway such as the amphetamines, cocaine, and Lysergic Acid (LSD). CASE REPORT: We report here two cases of dextromethorphan overdose that presented to the Pediatric Toxicology Service at Siriraj Hospital, Bangkok, Thailand. Both cases presented with hyper-agitation, confusion, with signs of sympathomimetic overdose. Both patients were treated with supportive care and fully recovered within 24 hours without sequalae. CONCLUSION: Although the acute toxicity of dextromethorphan is abated within 24 hours, its pharmacological properties still render it a dangerous drug to use alone or in combination with other drugs.

Successful treatment of intrathecal morphine overdose.

A 47-year-old woman was diagnosed with secondary progressive multiple sclerosis, and was treated with intrathecal morphine for chronic pain via a slow-release subcutaneous pump. She accidentally received a 35-ml (510 mg) bolus injection of morphine by this route, which led to status epilepticus. She was treated with continuous intravenous naloxone infusion, and with medication to control hypertension and stop the seizure activity. The outcome was excellent, and the patient returned to her neurological baseline. This report describes the complications and the successful treatment of intrathecal morphine overdose. In order to prevent these serious errors, it is vital that only care providers who are proficient with these devices perform the refilling procedure.

Accidental dextropropoxyphene poisoning.

Dextropropoxyphene poisoning is an uncommon accidental poisoning in children. Presentation is similar to narcotic over dosage or poisoning. Convulsions, conduction disturbances, arrhythmias and hypoglycemia are common. Naloxone is the antidote. As it is uncommon and not documented in children in Indian literature we are reporting this case.