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Related Concept Videos

Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
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Analgesia and Pain Management01:25

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Opioid Analgesics: Morphine and Other Natural Cogeners01:20

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Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
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Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists01:29

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Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
Phenothiazines, such as prochlorperazine...
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Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists01:28

Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists

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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Methadone in Cancer Pain.

S Ramkiran1, Raghu S Thota2

  • 1Department of Anaesthesiology, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Vishakapatnam, Andhra Pradesh, India.

Indian Journal of Palliative Care
|September 3, 2020
PubMed
Summary

Methadone is a versatile synthetic opioid effective for various pain types, including neuropathic and cancer pain, when other opioids fail. It is safe and effective as a first-line treatment when carefully managed by experienced providers.

Keywords:
MethadoneQTc intervalopioid rotationrefractory cancer pain

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Area of Science:

  • Pain Management and Palliative Care

Background:

  • Methadone, a synthetic opioid, is recognized for its efficacy in managing nociceptive and neuropathic pain.
  • It is increasingly adopted for complex pain syndromes, particularly in advanced cancer, where conventional opioids are insufficient.

Purpose of the Study:

  • To evaluate the role and acceptance of methadone as a first-line opioid therapy versus a second-line substitution.
  • To highlight methadone's utility in opioid rotation for refractory cancer pain and its advantages in pediatric oncology.

Main Methods:

  • Review of clinical applications and safety guidelines for methadone in pain management.
  • Analysis of methadone's efficacy in opioid-naive patients and during opioid rotation in outpatient settings.
  • Emphasis on careful titration and monitoring by experienced pain and palliative care providers.

Main Results:

  • Methadone demonstrates safety and efficacy as a first-choice opioid in pediatric advanced cancer patients.
  • Successful opioid rotation to methadone is achievable in refractory cancer pain, especially with early initiation.
  • Methadone is safe in opioid-naive patients when carefully titrated in ambulatory settings.

Conclusions:

  • Methadone is a valuable, cost-effective synthetic opioid for complex pain, including neuropathic and cancer pain.
  • Its role as an anti-cancer agent is a misconception; it should not be prescribed for this purpose.
  • Safe and effective use requires experienced prescribers, careful dose titration, and clinical monitoring, particularly regarding cardiac safety.