Transdermal fentanyl patch in the use of chronic and non chronic pain

Transdermal fentanyl patch in the use of chronic and non chronic pain What is Fentanyl? Transdermal Fentanyl is a synthetic narcotic analgesic that is widely used in clinical anaesthesia which was originally synthesised by Dr Paul Janssen in the early sixties. It is approximately one hundred times more potent that morphine; which is thought of a the golden standard for opiods; this is where other opiods are compared and tested against morphine. Due to its potency, Fentanyl is mainly used for chronic long term illnesses such as cancer; however it is also used in short term acute pain for example child birth (a Fentanyl epidural would be used in this situation). Fentanyl can be administrated in many ways, which include: patch, ionysys, lollipop, injection and epidural. Biochemistry Janssens synthesis of fentanyl was to reactN-phenethylpiperidone with aniline to create 4-anilino-N-phenethylpiperidine. This compound is then reacted with propionyl chloride to give pure fentanyl, which is toxic and must be diluted in order to administrate to patients. American Chemical society 2005. Transdermal Fentanyl works by binding itself to the  µ-opioid receptors found in the Central Nervous System and the Gastro-Intestinal tract. It has high lipid solubility therefore it binds strongly to plasma proteins and can quickly cross the blood-brain barrier. This in turn causes the patient to have a sense of euphoria by increasing the patients pain threshold (the amount of discomfort a person feels enough to consider pain) and reducing the sensitivity of pain. Side effects and Benefits Transdermal Fentanyl is a more popular choice among patients as it provides a better quality of life and produces fewer side effects compared to that of other opiods. The side effects of Fentanyl are generic for all opiods, these include; respiratory depression (where the patients breathing becomes depressed and slow) muscle spasms, abnormal blood pressure (could be both high or low), nausea, vomiting, blurred vision, itching (caused by the substance making direct contact with the skin), euphoria, dizziness, weight loss and constipation. On the other hand there are many benefits that come from using the drug, example; A longer period of release i.e. Fentanyl patch can be released throughout the body for a seventy two hour period using the patch; and according to clinical studies provides an improved pain relief compared to that of morphine. A smaller volume is needed due to its potency and less constipation and less sedation occurs (the patient recovers motor function quicker). Converting a patient onto Transdermal Fentanyl Patch from Morphine The direct adaptation from Morphine to Fentanyl was first determined and tried by cancer patients. These patients are seen to have a steady and unvarying level of pain, and are receiving a constant dosage of Morphine to relieve it. On unstable pain Fentanyl does not work at its best. Below is an example of a patient receiving 100mg IV Morphine Sulphate and is going home on Fentanyl patch. 1) Convert to 24h oral MS dose 100mg/ IV MS = x 10mg/d IV MS 30mg/d oral MS 2) Adjust for cross-Tolerance 300mg/d oral MS x 0.65†  = 200mg/d oral MS †  Deriving a 35% reduction is equivalent to multiplying by 0.65 3) Convert adjusting to dose to Fentanyl Transdermal Patch dose 200mg/d oral MS = 55 µ/hr Fentanyl Patch 3.6 4) Round to closest Fentanyl Patch dosage from (25, 50, 75, 100) 55 µ/hr → 50 µ/hr Fentanyl patch† Ã¢â‚¬   † Ã¢â‚¬  Replace patch every 3 days 5) Provide oral morphine q2-4h for a break-through -pain at 10% of 24hr period total 200mg/d oral MS x 0.10 = 20mg oral MS q2-4h prn breakthrough pain Ali Olyaei PharmD, 2005 Fentanyl patch The Fentanyl patch is generally deliberated if there is no access oral for the patient and is unable to take Fentanyl orally in a tablet/lozenge form or If the patient is reluctant to continue on morphine to due unpleasant side effects such as constipation, tolerance; or if the patient is know to overdose or not taking the medication this is where the patient will become supervised. The Transdermal Fentanyl patch is often seen as the most common and easy way to treat chronic and non-chronic pain. It allows the patient to self administer the drug at home and has the longest effect on the body. (Margaret Gibbs 2009) The Patch can also be assisted by the lollipop, by using it as a top up mechanism to pain relief. Many health care professionals suggest that the patch should only be used for patients who are opioid-tolerant and cannot successfully manage there pain with other dugs such as morphine. The Patch can come in two forms which include; a Reservoir patch, where the patch is suspended in a matrix and placed onto the skin; and a Matrix patch where the drug is distributed evenly throughout a matrix. Reservoir Patch The principle of this patch is to understand and evaluate the stability and skin penetration profiles of Fentanyl. For this patch the Fentanyl is limited within a reservoir within the patch in a gel form. Dangerous drugs, Justinian Lane 2010 Matrix Patch Unlike the Reservoir patch there is no Fentanyl gel contained within the patch. This style of patch places the Fentanyl within the adhesive so it makes direct contact with the skin. (Causing the side effect of itching). This design of patch is seen as safer as is it unable to leak gel. Dangerous drugs, Justinian Lane 2010 How to apply the Patch There are many guidelines according to Drug and Therapeutics Committee August 2009; that a patient is required to follow in order to use the patch successfully. * Apply to clean, hairless skin such as the upper arm (which has not exposed to radiotherapy) and seize in place for 1 minute. * The patch works by creating a deposit of drug under the skin through the pores of the skin. * The patch should be replaced every 72 hours. Rotate position so not to irritate the skin. * Avoid direct heat and if the patient has a fever observe for opioid toxicity. * Fentanyl is causes less constipation than morphine. Therefore use half the dose of laxative if needed and repeat. * Prescribe strong opioid for breakthrough with either immediate release morphine sulphate /oxycodone or subcutaneous strong opioid The Patch works by releasing Fentanyl (either from the matrix gel or the Fentanyl Adhesive) into the body fats through the pores of the skin, which in turn releases the drug slowly and constantly around the bloodstream eventually passing the blood brain barrier allowing it to bind to  µ-opiod receptors, giving a constant pain relief of between forty-eight and seventy-two hours which is usually constant. However, it takes approximately four- twelve hours for the patch to begin releasing Fentanyl into the body. At this point the Fentanyl lollipop would be used to keep the patients pain relief up. Dosage is based on the size of the patch and absorption rate is usually regular, depending on many factors which include body temperature, size of the patient, skin type, quantity of body fat, and placement of the patch; can all have major effects on pain relief and dosage. Fentanyl patches are manufactured in five sizes: 12.5  µg/h,25 µg/h, 50 µg/h, 75 µg/h and 100 µg/h. Fentanyl Lollipop The Transdermal Fentanyl Lollipop is a fast end effective method of administrating the drug, as the drug enters the body via mucous membranes in the mouth. It is primarily used as a top up method of pain relief in conjunction to the Fentanyl Patch, when the patient requires it. It is an beneficial form of administration as the lollipop doesnt require trained medical staff regarding administration Richard Payneb et al. It is preferred among patient as it is portable and fast-acting. The dosages for the lollipop are the following: 200  µg in gray 400  µg in blue 600  µg in orange 800  µg in purple 1200  µg in green 1600  µg in burgundy Fentanyl is prescribed after an assessment of the patients condition, medical history and known tolerance to pain medication, such as Morphine. In addition, the dosage is decided based on the severity of the pain over a twenty-four hour period. Conclusion To summarise Transdermal Fentanyl is a potent synthetic analgesic which was manufactured for the treatment of both chronic and non chronic pain management which include situations such as cancer or childbirth. It is widely used for the treatment of cancer as is it approximately one hundred times more potent than morphine which is described as the golden standard for opiods. The Fentanyl patch is manufactured in two different styles; Matrix and Reservoir; they work by diffusing the drug through the pores of the skin and allowing it to be transported around the bodys blood system furthermore crossing the blood barrier binding to the  µ-opiod receptors. The lollipop as a top up mechanism in conjunction according to the patients pain level. The patch is effective and preferred by patients as it has fewer side effects than the majority of opiods i.e. morphine, and provides the patient with a better quality of life as it can be administrated at home and last for approximately seventy-two hours. References ~ Margaret Gibbs, The role of transdermal fentanyl patches in the effective management of cancer painhttp, (June 2009) ://www.internurse.com Last accessed 1ts December 2009 ~ Last accessed 1st march 2010 (Online) http://www.medicinenet.com/fentanyl_transdermal_system/article.htm ~ Figure 1 (online) http://pubs.acs.org/cen/img/83/i25/8325fentanyl.gif ~ American Chemical society 2005 (online) Last accessed 10th March 2010 http://pubs.acs.org/cen/coverstory/83/8325/8325fentanyl.html ~ Drug and Therapeutics Committee August 2009 (online) Last accessed 12th March 2010 http://www.typepad.com/services/trackback/6a00d8341c716c53ef011571115245970c ~ Figure 2 (online) http://corpreform.typepad.com/.a/6a00d8341c716c53ef01157205fb1a970b-pi ~ Figure 3 (online) http://corpreform.typepad.com/.a/6a00d8341c716c53ef01157205fb2a970b-pi ~ Figure 4 (online) http://pi.watson.com/product_shot_images/00591_3213_72.jpg ~ Last accessed 12th march 2010 (online) http://www.fifeadtc.scot.nhs.uk/support/Fentanyl%20palliative%20care.pdf ~ Last accessed 12th march 2010 (online) http://www.typepad.com/services/trackback/6a00d8341c716c53ef011571115245970c ~ Richard Payneb et al (online) Oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough pain in cancer patients: a controlled dose titration study, (1999) Pain 79 303-312, Last accessed www.sciencedirect.com 21/01/2010

Zuma Beach Essay -- Descriptive Essay About A Place

  Ã‚  Ã‚  Ã‚  Ã‚  It was a sunny Friday afternoon when I decided to take my observations with me out into the world. I find that my imagination wanders off on its own and takes trips to the ocean without me so I figured my body had some catching up to do. With a snap of my fingers and a short ride through the canyon I found myself at my childhood playground, Zuma Beach. Without hesitation I laid my towel down upon the tiny grains and chips of rocks that the oceans might has turned into sand over the years. I took a moment to put my life on hold and gaze at what nature had to offer to me. I reflected upon all of the other places I could have been instead of standing with my toes curling in the warm sandy beach and smiled in appreciation of my situation.   Ã‚  Ã‚  Ã‚  Ã‚  It was perfect weather out for a day at the beach. The clear sky didn’t have a single cloud to block the rays of the radiant sun. I could sense the feeling of ultra relaxation from the outstretched deep blue canopy above and the penetrating warmth that emanated from the sky and wrapped around my skin like a warm blanket on a cold winter’s night. Every once in a while a cool breeze would pass by and ease away the sun’s intense heat bath for brief moment. I could feel grains of sand gently brush over the top of my feet with each gust of wind. The crisp ocean wind flowed through my nasal cavity and stung the inside of my nose. My lungs quivered in surprise at how light and fresh the air was since it was not drudgingly thick with smog or other pollutants. As the salty smell of the water hit my nose, I thought about all the time I had spent waiting in anticipation to get that first refreshing whiff of ocean air that confirmed arrival and signaled t he beginning of another exceptional beach experience.   Ã‚  Ã‚  Ã‚  Ã‚  I closed my eyes for a second to take in what I could observe through my auditory senses. The laughter of children and families enjoying the summer day brought a smile to my face as they smoothed the walls of their sand fortresses and played football in the sand. I could hear the ball churn through the air as the laces spun rhythmically from the spiral that left one hand and landed with a quiet thud as it found its way to the intended receiver. The dampened sounds of feet digging into sand were all around me from other visitors coming to plot their spot of temporary beach front residence for the afternoon. I could... ...onger alone in the water. It was humbling to see that there was so much going on around me that I did not know about. Suddenly, the water parted and the nose of a dolphin appeared. He was moving with such speed his whole body came out of the water like a cannon and followed the shape of a perfect arc as it cut through the atmosphere. His skin glistened in mid-air and looked like a slippery mirror in the hot summer sun. Mist sprayed from his tail as he stretched out in the air, and he shook it in a friendly manner greeting all of us watching. Then with a splash he disappeared back under the water and departed just as quickly as he appeared.   Ã‚  Ã‚  Ã‚  Ã‚  Every time I go to the beach I always walk away with a memorable experience. I can still remember meeting my friends there every summer Thursday when I was a child. Nothing about this place has changed. I still eat sandwiches that crunch with every bite from tiny grains of sand that get captured between the meats. I can still lie out on my towel and have good conversation with buddies that float us away to the times when we couldn’t even drive. This is a place of escape. I can’t wait to see what adventures will come to me the next time.

Mr. Know All Essay

Mr. K seems to be a fake person but finally he saves the lady’s life and marriage. It’s not always good to judge a book by its cover. A Road Not Take: How people in the world make decisions. Hots: * Inference. Interpreting the sigh (somewhere ages and ages hence) was he happy or not? It wasn’t that he wasn’t happy with his choice. It’s only he wanted to be able to walk through both paths. Once you’ve taken a single path you change your life forever. You can’t jump into the same river twice. You’re a different person, both you and the river change. Even if you do go back, you’re not the same person anymore. One path leads you to another. * Explaining a pattern. * Problem solving. How does he choose? How does he weigh the pros and cons? He uses this skill to compare and contrasts, he tries to see which one’s better which one was used more, in the end he just takes the one that wanted wear, the one that more people have walked on and that’s way we can’t be sure whether or not his choice was correct. He tried to see where the roads bend. (â€Å"I kept the other to another day† though we know he can’t bring back time†) maybe he’s choosing between good and good. Literary terms: * Symbolism. The path, time and day, yellow woods – either dawn (new beginning) or the seasons (fall) – a time of change. Metamorphosis. * Theme. What was he trying to tell us? Was he happy?. It’s one of hope and one of regret. It’s up to interpretation. There’s both regret and comfort. (The more correct – he’s not sorry about what he took but he’s sorry about the human feeling of having to have both and being forced to choose one. ) He has a dilemma and he has to make a decision. As I grew older: On the one hand Langston Hughes could be just a regular person who has dreams, and as he grows older his dreams are obliterated by a big wall causing a shadow and either he decide to break through it and achieve his goals. However, we know he was African American and the fact of him being black, made him who he is. By knowing how he feels about racism and discrimination, we understand the poem better. When he’s a kid he doesn’t understand he’s being put within a society in which he can succeed. But as he’s growing older he understands he can’t achieve what he wants to achieve with the current reality. When he becomes an adult he understand how limited he is. He lays there in the shadow looking at the wall. Then, he look at his dark black hand (negative connotation) on the other hand, these black hands are the ones that smash the wall into thousands of pieces of light. He’s his own master, he has the power. If he wants to do it he and only he can change is fate. HOTS: * Distinguishing different prospective – his perspective towards life change throughout the poem. (Kid – Insight – Won’t accept his fate). * Cause & Effect – he basically has to cause the effect. He’s the person (the simple man) who can take charge. He’s the only one who can change his fate and cause the effect. If there wasn’t a cause and he fact he’d just stay there lying looking at the wall grow older and older. He believes the discrimination is wrong but it’s not enough to talk and the action that he takes violently by smashing the wall and shattering the darkness might change his fate and then he’ll be able to achieve his dreams. Literary terms: * Symbols: mood, hand, theme, racism, discrimination. Read the poems and story and read all the questions. Read all the summaries. As I grew older – the question we answered on the board. How it’s being checked – 80% content,20% grammar.

Aristophanes View Of Love - 1243 Words

Our human nature was not what we always thought of it to be, in simpler times two were made as one. We roamed the earth in unity with our other halves without the burden of trying to find them. However, Zeus did not find this to be in his best interest because of how we behaved so he split each being in two. As a result of this split we must now go about our lives in search of our other half. This is the speech that Aristophanes gave in Plato’s Symposium a book composed of various speeches from many different famous Greek people. Aristophanes’ view of love is compelling because it describes our very human nature to find our love, it justifies the reasoning of why there are different sexualities, and it gives an explanation as to why our bodies are the way that they are today. The main idea of Aristophanes’ speech is that humans were not the way that they are today mentally, physically or emotionally. â€Å"Each of us, then, is a ‘matching half’ of a human whole, because each was sliced like a flatfish, two out of one, and each of us is always seeking the half that matches him† (p.27, 191E). What is most compelling about this is that here Aristophanes explains the yearning that people have for love in their lives. Due to this split many may feel as if a piece of them is missing and they may only find it once they find that person who they were once in union with. As stated previously this is where Aristophanes puts into perspective the notion that everyone truly has their otherShow MoreRelated Aristophanes Agathon in Women at the Thesmophoria Essays1459 Words   |  6 PagesAristophanes Agathon in Women at the Thesmophoria Aristophanes and Agathon were peers in Ancient Greece. Aristophanes was the master of comedy, and Agathon was the master of tragedy. 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