Abstract:
:Because rates of both opioid prescribing and opioid abuse have increased, drug companies have responded by considering strategies to make opioid formulations less attractive for abuse without compromising safety or efficacy for patients with legitimate pain management needs. The emergence of tamper-resistant opioid formulations is intended to deter abuse by creating obstacles to crushing or dissolving opioid tablets and capsules. At present, 2 long-acting and 1 immediate-release (IR) opioids are available in tamper-resistant formulations. Oxycodone controlled-release and oxymorphone extended-release tablets have each been reformulated with a hardened matrix that resists crushing or dissolution in liquids, making them difficult to prepare for nasal insufflation or intravenous use. Oxycodone IR has been reformulated with aversive ingredients that create nasal discomfort if the tablet is crushed and insufflated. Tamper-resistant opioid formulations are likely to be selected for patients who are identified as being at risk for abuse. However, patients vary in their response to individual opioids and may require rotation to a series of alternative opioids before finding one that is effective and sufficiently well tolerated. With only a few tamper-resistant opioid formulations currently available, switching and rotation may become difficult. As a result, patients who do not respond to a tamper-resistant opioid formulation or experience intolerable adverse events may require rotation to a formulation without tampering safeguards. Prescribers will need to be on guard for patients who may make false claims of poor response or adverse events to avoid tamper-resistant opioid formulations. Moreover, prescribers need to be aware of any tamper-resistance mechanisms that may affect efficacy or tolerability in patients with legitimate pain management needs compared with formulations without tampering safeguards.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Pappagallo M,Sokolowska Mdoi
10.3810/pgm.2012.09.2588subject
Has Abstractpub_date
2012-09-01 00:00:00pages
101-9issue
5eissn
0032-5481issn
1941-9260journal_volume
124pub_type
杂志文章abstract::Cecal volvulus is a malrotational abnormality of the intestine that causes obstruction. Diagnosis is difficult and, if delayed, the results may be intestinal ischemia, perforation, sepsis, and even death. Cecal ischemia or gangrene cannot always be determined from physical and laboratory findings. Although not always ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716164
更新日期:1982-08-01 00:00:00
abstract::Common dislocations that can usually be managed in the office include anterior dislocations of the shoulder, posterior dislocations of the elbow and joints of the fingers and toes, and lateral dislocations of the patella. A systematic approach based on an understanding of the mechanism of injury, roentgenographic docu...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11714687
更新日期:1977-11-01 00:00:00
abstract::Findings from 441 patient evaluations performed at the Taste and Smell Clinic of the Connecticut Chemosensory Clinical Research Center are presented. Taste and smell dysfunction was the chief complaint in all patients. The diagnostic approach included tests of taste and smell function; history taking; physical, neurol...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699680
更新日期:1987-01-01 00:00:00
abstract::Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and is associated with poor clinical outcomes, including an increased risk of all-cause and cardiovascular mortality, as well as adverse economic and social effects. Slowing the development and progression of CKD remains an unme...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2019.1601404
更新日期:2019-05-01 00:00:00
abstract::Inhaled corticosteroids (ICSs) belong to the armament for treatment of chronic obstructive pulmonary disease (COPD) and as such, they are widely used in real life. This is a narrative review on evidence-based papers published in the English language listed in Medline between 1990 and March 2016 discussing ICS applicat...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1186487
更新日期:2016-06-01 00:00:00
abstract::Our diagnostic approach to a patient with dysphagia begins with detailed history taking and physical examination. On the basis of findings, a radiographic and/or endoscopic study of the esophagus is done. We usually have barium-swallow radiography done initially, and if the radiographs are equivocal, upper gastrointes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701537
更新日期:1992-11-15 00:00:00
abstract::Solid organ transplantation is now the standard of care for end-stage organ failure, and primary care physicians are frequently involved in the follow-up care of transplant recipients. New-onset diabetes mellitus after solid organ transplantation (NODAT) has emerged as an increasingly important determinant of outcomes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2008.07.1792
更新日期:2008-07-01 00:00:00
abstract::The clinical history and physical examination remain the most important factors in determining the presence, anatomic location, and physiologic extent of arterial occlusive disease and the need for operation. The physician should refrain from ordering arteriography to confirm the diagnosis of arterial disease unless o...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11714271
更新日期:1976-02-01 00:00:00
abstract::According to Cato Institute chairman William A. Niskanen, government-mandated managed competition will fail to control healthcare costs and will pose a serious threat to the quality of American medical care. Mr Niskanen elaborates on this viewpoint in the following remarks, which were originally delivered in a speech....
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1994.11945814
更新日期:1994-03-01 00:00:00
abstract::Platelets play a key role in the initiation of hemostatic mechanisms during vascular injury. When contemplating prescription of antiplatelet agents (APAs) for patients as primary prevention for cardiovascular events, the physician should carefully weigh the potential benefits of cardiovascular risk reduction with the ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2013.09.2694
更新日期:2013-09-01 00:00:00
abstract::While the appropriateness of giving medical advice on the telephone could be debated, this discussion is based on the assumption that few physicians can avoid providing this service to their patients. In fact, most physicians must respond often to telephone requests for advice. A large portion of these "emergency" cal...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699699
更新日期:1987-02-01 00:00:00
abstract:OBJECTIVE:Opioids with abuse-deterrent properties may reduce widespread abuse, misuse, and diversion of these products. This study aimed to quantify misuse, abuse, dependence, and health resource use of extended-release morphine sulfate with sequestered naltrexone hydrochloride (ER-MSN; EMBEDA®), compared with non-abus...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2019.1585688
更新日期:2019-04-01 00:00:00
abstract::The prevalence of obesity and diabetes is epidemic. Severe insulin resistance (defined as the need for > or = 200 units of insulin per day to achieve glycemic control) is commonly seen with obesity and can complicate diabetes management. The management of patients with diabetes who have severe insulin resistance is di...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2010.01.2110
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:To evaluate healthcare resource utilization (HCRU) by osteoarthritis (OA) pain severity. METHODS:Cross-sectional surveys of US physicians and their patients were conducted between February and May 2017. Using the Numeric Rating Scale, patients were classified by self-reported pain intensity in the last week ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1841988
更新日期:2021-01-01 00:00:00
abstract::Hair analysis has important uses in screening for metal intoxication and exposure to environmental pollutants, as well as applications in forensic medicine. In addition, hair analysis has been hailed as the new "in" tool for diagnosis of nutritional deficiencies and chronic diseases, but data to support these applicat...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716248
更新日期:1982-11-01 00:00:00
abstract::Preview Although heartburn is the most common symptom of gastroesophageal reflux, many patients with reflux have other, more obscure manifestations. Recognition of all potential signs and symptoms of reflux is important for expeditious management. This article focuses on these atypical presentations and discusses how ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1996.11946110
更新日期:1996-04-01 00:00:00
abstract::Colonic cancer remains a major cause of death because diagnosis is usually delayed. Improved methods for earlier detection will maximize the patient's chances for survival. At present, surgery offers the greatest possibility of cure, but even in those instances where less than definitive resection is possible, there i...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1975.11714014
更新日期:1975-04-01 00:00:00
abstract::Oxygen therapy is tremendously valuable for patients with chronic respiratory insufficiency. A physician's prescription is needed to obtain Medicare, Medicaid, or insurance-company reimbursement, and certain guidelines must be followed: Patients are selected if significant hypoxemia is present, appropriate pharmacolog...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700464
更新日期:1988-11-01 00:00:00
abstract::Combination therapy is a cost-effective and rational approach to treatment of severe hypertension and of mild to moderate hypertension that is refractory to monotherapy. The method has several advantages, most notably improved tolerability and enhanced antihypertensive efficacy. Long-term prospective studies are neede...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.09.581
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:In October 2012, the American College of Rheumatology (ACR) published recommendations for chronic gout treatment goals and pharmacotherapy. OBJECTIVES:Identify potential gaps between real-world chronic gout treatment, ACR guideline recommendations, and physicians' perceived guideline adherence by evaluating...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2014.05.2774
更新日期:2014-05-01 00:00:00
abstract::Scleroderma, psoriasis, lichen planus, and other skin disorders may signal a more serious internal disease. Physicians who recognize such clues can initiate early treatment while disease is in its early stages. The authors of this article describe several of the more common dermatologic conditions linked to systemic d...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.06.227
更新日期:1997-06-01 00:00:00
abstract::In most cases, patients presenting with "the worst headache ever" are found to have a benign condition, notably migraine, toxic vascular headache, or exertion-induced headache. However, ominous causes first must be excluded by appropriate investigation, such as computed tomographic or magnetic resonance imaging scans ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1989.11704328
更新日期:1989-07-01 00:00:00
abstract::Persistent hoarseness in a patient should always alert the physician to the possibility of laryngeal carcinoma. Prompt visualization of the larynx is essential, particularly in high-risk patients over 40 years of age without a history of upper respiratory infection. Mirror examination (indirect laryngoscopy) is the us...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715452
更新日期:1980-05-01 00:00:00
abstract::Hemorrhoids are a common source of anorectal symptoms, which are determined by their size. A helpful measure in small hemorrhoids is a high-fiber diet; in moderate lesions, ligature therapy is effective. Surgery should be reserved for large hemorrhoids. Anal fissures, probably caused by trauma to the anal canal during...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-11-01 00:00:00
abstract::Diabetic foot infections (DFIs) are a commonly encountered medical problem. They are associated with an increased frequency and length of hospitalization and risk for lower-extremity amputation. Furthermore, they have substantial economic consequences. Patients with diabetes mellitus are particularly susceptible to fo...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2012.03.2541
更新日期:2012-03-01 00:00:00
abstract::The incidence of nonmelanoma skin cancer is rapidly increasing. With early diagnosis and treatment, almost all basal cell and squamous cell carcinomas can be cured. Premalignant actinic keratoses are treated with cryosurgery; the CO2 laser is the treatment of choice for actinic cheilitis. Generally, nonmelanoma skin c...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract::Thymomas may be discovered during routine evaluation, through reported symptoms, or increasingly, during evaluation for myasthenia gravis. Histologic details of these tumors have little bearing on prognosis or evaluation of malignant potential. Malignancy is determined by evidence of invasion through the tumor capsule...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699321
更新日期:1986-03-01 00:00:00
abstract::Bronchiectasis belongs to the family of chronic obstructive lung diseases, even though it is much less common than asthma, chronic bronchitis, or emphysema. Clinical features of these entities overlap significantly. The triad of chronic cough, sputum production, and hemoptysis always should bring bronchiectasis to min...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.07.607
更新日期:1999-07-01 00:00:00
abstract::Hypertension is a leading contributor to the burden of cardiovascular disease. The importance of lowering blood pressure (BP) to reduce the risk of cardiovascular events has been demonstrated in numerous clinical trials. Most patients require combination antihypertensive therapy utilizing agents from complementary dru...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2009.03.1974
更新日期:2009-03-01 00:00:00
abstract::When confronted with a patient with an alteration in mental status following surgery, the physician must consider both organic and psychosocial causes and their synergistic interactions. A careful medical assessment will rule out metabolic disorders, sepsis, cardiopulmonary complications, and adverse drug effects. A m...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715409
更新日期:1980-03-01 00:00:00