Oncology Professional Rebels Network

Prescription Opioids Available in Canada

2017-02-24T10:16:00.000-07:00

The following table highlights currently available prescription opioids in Canada, including formulations and strengths. Any of the coverage notes are specific to the province of Alberta.

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Credit: Table composed by Kevin Thai and Humirah Sultani

Virtual Conference: CAPhO's Oncology Fundamentals Day October 1, 2016

2016-09-20T10:13:00.000-06:00

What a brilliant initiative from CAPhO's (Canadian Association of Pharmacy in Oncology) Education Committee! A virtual conference on oncology pharmacy fundamentals - fully accredited.

Are you new to oncology or a general pharmacy practitioner with cancer patients in your practice?
Are you looking for core education on common oncology diseases and cancer treatment toxicities?

Attend the Canadian Association of Pharmacy in Oncology (CAPhO) Oncology Fundamentals Day (#OFD16), taking place on Saturday, October 1, 2016. Join us for a full day CCCEP accredited online professional development opportunity from wherever you are. The program information is found at the link below:
http://www.capho.org/oncology-fundamentals-day-program

Losing That Restless Feeling: Drug-Induced Akathisia Treatment Options

2015-07-21T14:05:00.001-06:00

Akathisia

Akathisia (from the Greek καθίζειν: inability to sit) is one of the most prevalent and distressful psychotropic-induced extrapyrimidal adverse effects. It is a neuropsychiatric syndrome characterized by both subjective (inner feeling) and objective (physical symptoms) restlessness.

Due to this inner restlessness, patients may experience fidgeting, pacing, rocking while standing or sitting, crossing and uncrossing legs while sitting, and constant movement of the feet. Patients have also described these feelings as “wanting to jump out of my skin”and as a “crawling skin sensation.” (4)

Among the drugs used to treat delirium, haloperidol, might be the antipsychotic with the highest risk for development of akathisia. (5) The risk for akathisia in patients with delirium taking antipsychotics appears to be a dose-related phenomenon. Effective and well tolerated treatment is a major unmet need in akathisia that merits a search for new remedies.

Assessment Scales

"Studies using specific scales for evaluation of akathisia in delirium are lacking. Some populations, such as patients with cancer or terminally ill patients in palliative care settings taking antipsychotics for the treatment of delirium, could be at higher risk for development of akathisia as a side effect." (5)

The Barnes Akathisia Rating Scale (BARS) is one such scale.

Treatment

Early management of akathisia is important because it may be associated with poor treatment response and medication noncompliance, and most importantly is distressing to the patient and caregivers. Unfortunately many patients fail to respond to standard management of akathisia (typically benzodiazepines, beta blockers, anticholinergic agents). As medications used to alleviate akathisia symptoms such as anticholinergics and benzodiazepines could potentially worsen delirium, management of akathisia among delirious patients on antipsychotics should be further studied to explore the efficacy of other agents.

In addition to dopaminergic mechanisms, it has been hypothesized that serotonin may play a prominent role in the pathophysiology of akathisia.

Trazodone is an antidepressant agent demonstrating prominent serotonergic antagonistic properties. An open-label pilot study investigated the efficacy of trazodone in the management of akathisia. Nine female patients with a score of at least “mild akathisia” on the Barnes Akathisia Scale, and receiving a stable dose of antipsychotic medication, were administered trazodone, titrated up to a dosage of 100 mg/day over a period of 5 days. The patients demonstrated marked improvement in symptoms of akathisia. In addition, some improvement was noted in symptomatology of anxiety, depression, and psychosis. (3)

Low-dose mirtazapine was found to be efficacious for neuroleptic-induced akathisia. (2) "The most compelling evidence indicating that 5-HT2A antagonists may represent a new class of effective anti-akathisia agent comes from the largest-to-date randomised controlled trial comparing low-dose mirtazapine with propranolol in 90 patients with FGA-induced (first-generation antipsychotics) acute akathisia. Mirtazapine is characterised by potent presynaptic alpha-2 adrenergic antagonism, which accounts for its antidepressant activity, and marked 5-HT2A blockade that seems to preponderate in a low dose and contribute to its anti-akathisia properties. Mirtazapine, given once daily (15 mg) was as effective as propranolol (80 mg twice daily) in producing a greater improvement in akathisia compared with placebo (reduction in BARS global scale: 1.10 (s.d. = 1.37) points (34%) and 0.80 (s.d. = 1.11) points (29%) v. 0.37 (s.d. = 0.72) points (11%) respectively; P = 0.036). Responder analysis (BARS global scale reduction 52) yielded a similar robust anti-akathisia effect in mirtazapine and propranolol v. placebo (43.3% and 30% v. 6.7% respectively; P = 0.005). Low numbers needed to treat (3 and 4 respectively) support high clinical efficacy of both compounds. Importantly, mirtazapine achieved an anti-akathisia effect with more convenient dosing than propranolol and better tolerability, with mild transient sedation as the only observed side-effect. The favourable mirtazapine safety profile was also supported by the absence of significant changes in vital signs." (1)

Suggested Approach

Discontinue [alternatively, dose decrease] the offending agent. If this is not possible or ease of symptoms is required, when the decision is to add an anti-akathisia agent

propranolol (40–80 mg/day twice daily) or

low-dose mirtazapine (15 mg once daily) as first-line treatment have the most supportive evidence.

Mianserin (15 mg once daily) and cyproheptadine (8–16 mg/ day) are alternative options

however, large-scale trials are not yet available. (1)

References

1. http://bjp.rcpsych.org/content/bjprcpsych/196/2/89.full.pdf

2. http://journals.lww.com/intclinpsychopharm/Abstract/2014/09000/Beneficial_effect_of_low_dose_mirtazapine_in_acute.8.aspx

3. http://www.researchgate.net/publication/10728695_Treatment_of_neuroleptic-induced_akathisia_with_the_5-HT2A_antagonist_trazodone

4. http://www2.nami.org/Template.cfm?Section=ask_the_pharmacist&template=/ContentManagement/ContentDisplay.cfm&ContentID=128836

5. http://www-ncbi-nlm-nih-gov.login.ezproxy.library.ualberta.ca/pubmed/26087817

Opioids Available in Canada

2015-07-10T14:34:00.000-06:00

The following table highlights currently available prescription opioids in Canada, including formulations and strengths. Any of the coverage notes are specific to the province of Alberta.

Click on the download icon (upper right hand corner) or the title below to view table in full screen mode.

Opioids Available in Canada:

Medical Marijauna: All Formulations Now Legal; Cannabis Harms Brain, Fails in Cancer Pain Study

2015-06-11T15:21:00.003-06:00

1. You might have heard the news by now:

- Ruling in Canada this AM:

Medical marijuana legal in all forms, Supreme Court rules (via CBC)

Excerpt:

"Medical marijuana patients will now be able to consume marijuana — and not just smoke it — as well as use other extracts and derivatives, the Supreme Court of Canada ruled today."

This is an important ruling for patients as we see more and more form - for instance, with cannabis oil being all the buzz these days.

2. That's the "good" news for patients; now for some sobering updates:

Cannabis Harms Brain, Imaging Shows (via Medscape)

Excerpts:

" The heavy, long-term use of cannabis is associated with negative changes in parts of the brain not previously implicated, and is linked to deficits in learning and memory, new research suggests."

"Cannabis shares a negative impact on dopaminergic transmission with other drugs, only with a different regional profile," explained Dr Abi-Dargham. An exploratory analysis showed a significant association between lower dopamine release capacity in the associative striatum and decreased cognitive measures in probabilistic category learning and working memory tasks, Dr Weinstein reported.

In their study, the team compared 11 heavy cannabis users with 12 healthy control subjects, all approximately 28 years of age."

"The blunting of dopamine release that they find fits with other studies showing reduced dopamine synthesis in cannabis users. This could be linked to the addictive potential of cannabis and other problems, such as lack of motivation, seen in regular users," Dr Howes told Medscape Medical News."

3. From January, but relevant when considering prescribing Sativex (which has refractory advanced cancer pain as indication in Canada):

GW Pharma's cannabis drug [Sativex] fails in cancer pain study, shares fall (via Reuters)

Excerpts:

"An experimental cannabis drug failed to alleviate pain in cancer patients as hoped in a clinical study, sending shares in its British maker GW Pharmaceuticals as much as 21 percent lower on Thursday. GW, which is developing the drug Sativex for pain in collaboration with Japan's Otsuka, said the first of three late stage trials found no statistically significant difference between subjects using its product and those given a placebo.

GW Chief Executive Justin Gover said the findings were both disappointing and surprising, given encouraging results in earlier tests, but the company's scientists had not given up hope. Results from two further Phase III trials are due later this year and, if positive, could still allow the drug to be submitted for treating pain in patients with advanced cancer, where it is designed to be given on top of opioids.

"Although we missed the primary endpoint in this trial, based upon the positive data seen in the Phase II programme, we remain confident in the ability for Sativex to relieve cancer pain in this patient population,” Gover said."

Expired Medications: Drugs past the "best before date" may lose potency, but how soon?

2015-04-14T10:14:00.001-06:00

Medications past best before date may lose potency, but how soon? | Canadian Healthcare Network - Pharmacists:

Excerpt of key points from the article:

"Suggesting it’s better to be safe than sorry, Emberley [Phil Emberley, director of pharmacy innovation at the Canadian Pharmacists Association] advises consumers to cull any out-of-date drugs from their medicine cabinets and take them to a pharmacy to be destroyed.

Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, said concerns about diminished potency depends on the drug and how much time has elapsed since the best-before date.

“For most drugs, the passage of a short amount of time after the expiry date is really of little clinical consequence,” he said. “In general, something that’s six to 12 months past the expiry date, with rare exceptions, is not going to be a problem at all. They’re not going to be dangerous.”

A 2012 study of a small number of drugs—some of them bottled or packaged 40 years earlier—found that active ingredients did degrade over time, but some more than others. For instance, researchers found ASA pills dropped in strength from 200 milligrams to two milligrams, while codeine barely lost any of its chemical constituents.

“It’s not like milk, and it’s not as though something magical happened on the expiry date and the drug loses all of its potency,” Juurlink said. “With most, but not all, it’s probably safe to take drugs that have expired recently. But the more time that has elapsed from the expiry date, the less advisable it becomes.”

Link to full article: click here

Opioid Tapering Guidelines

2015-04-07T12:02:00.001-06:00

McMaster University > Michael G. DeGroote National Pain Centre > Canadian Guideline for Opioid Use for Pain — Appendix B-12: Opioid Tapering:

"Rate of the Taper
The rate of the taper can vary from 10% of the total daily dose every day, to 10% of the total daily dose every 1–2 weeks.

Slower tapers are recommended for patients who are anxious about tapering, may be psychologically dependent on opioids, have co-morbid cardio-respiratory conditions, or express a preference for a slow taper.
Once one-third of the original dose is reached, slow the taper to one-half or less of the previous rate.
Hold [or increase] the dose when appropriate:
The dose should be held or increased if the patient experiences severe withdrawal symptoms, a significant worsening of pain or mood, or reduced function during the taper."

Click here for link to the article

eLearning: Lancet Oncology Podcasts

2015-04-07T11:39:00.000-06:00

Lancet Oncology produces podcasts - the frequency looks to be about every 2 to 4 weeks.

Click here for the link and learn while you're on the go.

Please share in the comments section below any oncology or palliative related podcasts that you find helpful or Tweet me @OncoPRN.

"Palliative Care" - The Words We Use

2015-01-19T13:56:00.000-07:00

Via Pallium Canada, who have been producing a great series of videos helping to bridge the gap with respect to some of the misconceptions surrounding palliative care.

"Supportive Care…Supportive Oncology…The Comfort Team…The Butterfly Team (as may be heard in pediatrics)…

Why is there so much resistance to the use of the “P” word – palliative? The truth is, palliative care might not be what many people think it is.

Language provides us with a tapestry of tools for communication and understanding. In palliative care, the use of poetic license is certainly no less than in any other fields of medicine. However, the words we use can be confusing."

Choose your words wisely...

Palliative Care: Better Early Than Late

2014-08-03T12:38:00.001-06:00

The much referred to NEJM Temel article highlighted the positive impact of early palliative care in terms of symptom management and even extending life. The Pallium group summarize this nicely:

Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Clinical Practice Guideline

2014-05-05T09:34:00.001-06:00

ASCO has recently published guidelines for the prevention and management of CIPN. Unfortunately, but not surprisingly even after a robust medical literature search, there are no revolutionary breakthroughs for the treatment or prevention of chemotherapy-induced neuropathy (CIPN). Here is a summary of the publication:

[You will also find this web page linked on the left hand side permanently under "Useful Links"]

"Recommendations: On the basis of the paucity of high-quality, consistent evidence, there are no agents recommended for the prevention of CIPN. With regard to the treatment of existing CIPN, the best available data support a moderate recommendation for treatment with duloxetine. Although the CIPN trials are inconclusive regarding tricyclic antidepressants (such as nortriptyline), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine, these agents may be offered on the basis of data supporting their utility in other neuropathic pain conditions given the limited other CIPN treatment options. Further research on these agents is warranted."

Link to the guidelines, summary, slide deck, etc. at ASCO website: click here

Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline | ASCO.org

"Cancer: The Emperor of All Maladies" Preview at AACR Annual Meeting 2014

2014-04-13T13:04:00.001-06:00

"The American Association for Cancer Research (AACR), the world's oldest and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer, is proud to be an outreach partner for "CANCER: The Emperor of All Maladies," a film documentary presented by Ken Burns. Based on the book "The Emperor of All Maladies: A Biography of Cancer" by Siddhartha Mukherjee, M.D., the film will air on PBS in spring 2015. The AACR is an outreach partner for the documentary, along with Stand Up To Cancer (SU2C), a program of the Entertainment Industry Foundation (EIF) that works to accelerate innovative cancer research and to increase awareness about progress being made in the fight against the disease."

Video: Healthcare Professionals on Twitter: Worldwide Growth Mapped 2006-2014

2014-03-22T11:13:00.001-06:00

"Video maps growth in doctors, nurses and healthcare professionals using Twitter since its launch in 2006 to 2014. Data sourced using Creation Pinpoint, the world's largest research tool for learning from healthcare professionals in public social media."

Valproic Acid Linked with Reduced Risk of Developing Head and Neck Cancer

2014-03-19T10:09:00.003-06:00

Sodium valproate is a common mood stabilizer (Photo credit: Wikipedia)

I was surprised to read this press release this morning concerning valproic acid, an antiepileptic, mood stabilizing medication that has also been used traditionally in the management of neuropathic pain.

I am interesting in seeing the doses most commonly encountered and the relevant toxicities. As PCF-4 (PalliativeDrugs.org) notes, no single mode of action accounts for its anti-seizure activity. It is a:

sodium and T-type calcium channel blocker
an NMDA receptor-channel blocker (?helpful in hyperalgesia)
alters GABA (distinctively selective for midbrain), dopamine and serotonin transmission

T-type calcium channels have been implicated in thalamic burst firing (absence seizures), neuropathic pain and possibly in regulating pain excitation thresholds in a 'T-rich' subset of peripheral nociceptors.

Beneficial effects have been reports in cancer-related neuropathic pain in Europe and Australia, but mixed results in other pain scenarios. Onset of action can often be within 24 hours for neuropathic pain.

But I digress - on to the news of the day:

Excerpt of Press Release via Wiley:

"A new study indicates that a commonly used mood stabilizing drug may help prevent head and neck cancer. The study is published early online in CANCER, a peer-reviewed journal of the American Cancer Society.

Valproic acid (VPA) is currently prescribed as an anti-seizure medication and mood stabilizer, but it is also being studied as an anticancer agent because it inhibits histone acetyl transferases, which help control gene expression by changing DNA structure.

Johann Christoph Brandes MD, PhD, of the Atlanta Veterans Affairs Medical Center and Emory University in Atlanta, led a team that assessed the anticancer effects of VPA in a study of 439,628 veterans, of whom 26,911 were taking the medication for bipolar disorder, post-traumatic stress disorder, migraines, and seizures.

Veterans who took VPA for at least one year had a 34 percent lower risk of developing head and neck cancer compared with those who did not take the medication. Higher doses and longer duration of VPA use seemed to provide additional benefits. No significant differences were observed for lung, bladder, colon, and prostate cancer incidences.

“A 34 percent risk reduction for the development of head and neck cancer with VPA use could result in the prevention of up to approximately 16,000 new cases and 3,000 to 4,000 annual deaths in the US alone,” said Dr. Brandes. “Head and neck cancer is an important global health crisis, and low cost and low toxicity prevention strategies like VPA use have a high potential impact on pain, suffering, costs, and mortality associated with this disease.”

Article: “Long-term use of valproic acid in United States Veterans associates with reduced risk of smoking related head-and neck cancer.” Hyunseok Kang, Theresa Gillespie, Michael Goodman, Seth Brodie, Mina Brandes, Maria Ribeiro, Suresh Ramalingam, Dong Shin, Fadlo Khuri, and Johann Christoph Brandes. CANCER; Published Online: March 24, 2014 (DOI: 10.1002/cncr.28479).

URL Upon Publication: http://doi.wiley.com/10.1002/cncr.28479

Treating ‘phantom limb pain’ with mirror therapy - Mirror Box Therapy

2014-03-18T09:55:00.001-06:00

A mirror box used for treating phantom limbs, developed by V.S. Ramachandran. (Photo credit: Wikipedia)

Treating ‘phantom limb pain’ with mirror therapy | mirror box therapy:

"Whether the phantom is in the hand or the foot the principle of mirror box therapy is still the same. In this video soldier Bryan Wagner talk us through his phantom and how mirror box therapy help him cope with the pain."

Link to full article and video

The WPCA - Global Atlas of Palliative Care

2014-03-03T09:32:00.001-07:00

The WPCA - Global Atlas of Palliative Care:

"Published jointly by the World Health Organization and the Worldwide Palliative Care Alliance, the Atlas is the first document to map the need for and availability of palliative care globally.

Using maps, graphs and case studies, and drawing on a wealth of resources, the Atlas addresses the following questions:

What is palliative care?

Why is palliative care a human rights issue?

What are the main diseases requiring palliative care?

What is the need for palliative care?

What are the barriers to palliative care?

Where is palliative care currently available?

What are the models of palliative care worldwide?

What resources are devoted to palliative care?
What is the way forward"

Read the full article here

VTE Treatment and Secondary Prevention in Cancer Patients

2014-02-25T11:55:00.001-07:00

CancerThrombosis.org :: Treatment and Secondary Prevention:

"The American Society of Clinical Oncology guideline: Recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer
Key recommendations for secondary prevention of recurrent VTE19"

LMWH is the preferred approach for the initial 5 to 10 days of anticoagulant treatment of the cancer patient with established VTE

LMWH given for 6 months is also the preferred approach for long-term anticoagulant therapy. Vitamin K antagonists with a targeted INR of 2 to 3 are acceptable for long-term therapy when LMWH is not available

After 6 months, indefinite anticoagulant therapy should be considered for selected patients with active cancer, such as those with metastatic disease and those receiving chemotherapy

The insertion of a vena cava filter is only indicated for patients with contraindications to anticoagulant therapy and in those with recurrent VTE despite adequate long-term therapy with LMWH

For patients with CNS malignancies, anticoagulation is recommended for established VTE as described for other patients with cancer. Careful monitoring is necessary to limit the risk of hemorrhagic complications. Anticoagulation should be avoided in the presence of active intracranial bleeding, recent surgery, preexisting bleeding diathesis such as thrombocytopenia (platelet count <50 coagulopathy="" font="" l="" or="">

For elderly patients, anticoagulation is recommended for established VTE as described for other patients with cancer. Careful monitoring and dose adjustment is necessary to avoid excessive anticoagulation and further increase in the risk of bleeding

For full article including great summary charts and diagrams as well as other key player guidelines, click here.

Personalized Cancer Treament, From Just a Blood Sample

2014-02-22T16:14:00.001-07:00

Personalized Cancer Treament, From Just a Blood Sample - The Crux | DiscoverMagazine.com:

"A technique being developed by San Diego–based Epic Sciences can determine whether a cancer patient is an appropriate candidate for a drug, and even whether the drug is losing its efficacy.

In research presented last month at the Personalized Medicine World Conference in Palo Alto, CA, Epic described how their technology can be used to reliably pick out rare cells from a blood sample. In the case of cancer, these rare, circulating tumor cells could one day tell an oncologist not only whether a patient’s cancer has returned, but also whether it’s growing resistant to the current treatment regimen—something only expensive scans and invasive biopsies can do with any accuracy today."

Read the full article here

Medications Can Affect Sexes Differently

2014-02-13T14:28:00.001-07:00

English: Chemical structure of zolpidem (Photo credit: Wikipedia)

Sex matters: Drugs can affect sexes differently - CBS News:

"Ambien, Zolpidem, is now the only prescription drug in the country with a different suggested dose for men and women. But we’ve discovered it is far from an isolated example of differences between the sexes we never imagined. More and more, scientists are realizing that the differences are dangerously understudied and that pervasively and fundamentally, sex matters.
Take aspirin. Low-dose aspirin lowers the risk of heart attacks in healthy men; but in healthy women, turns out it doesn’t though it does protect women against stroke.

And drugs are just the beginning. Sex differences have been found in pain receptors, liver enzymes, even the wiring of the brain."

Read full article: click here

Could Electronically Controlled Drugs Reduce Adverse Effects? (CNET)

2014-02-09T17:10:00.001-07:00

Could electronically controlled drugs reduce side effects? | Cutting Edge - CNET News:

In the realm of oncology this could have especially dramatic ramifications.

Excerpt:

"Reporting in the journal ACS Nano, researchers led by Dr. Xinyan Tracy Cui at the University of Pittsburgh say their new approach allows them to electronically control the release of very specific amounts of drugs to certain parts of the body. To do this, they incorporated extremely thin nanosheets of graphene oxide that were loaded with the anti-inflammatory drug dexamethasone into a polymer scaffold that conducts electricity. By zapping the nanosheets with an electric current, they were able to release the drug -- using the thickness of the sheets to control how much drug was being carried, and the number and magnitude of zaps to control how much of the drug was released."

Full article: click here

Fentanyl Transdermal Patch Application Sites

2014-01-23T12:35:00.001-07:00

English: 2D structure of fentanyl (Photo credit: Wikipedia)

We know that fentanyl patches should be applied to dry, noninflamed, non-irradiated, hairless skin. Body hair may be trimmed but not shaved. Be sure to press the patch firmly in place for 60 seconds or more. If problems with adherence, use Tegaderm or Micropore.

Fact or Fiction From Medscape:

Q: Is it true that fentanyl patches infuse more quickly in patients with very little subcutaneous fat?

A: No. The amount of fentanyl absorbed is proportional to the surface area of the patch. The absorption rate does not vary to any clinically significant extent between the chest, abdomen, and thigh.^[5] Fentanyl is released from the patch into top layers of the skin (stratum corneum and epidermis), and it accumulates within these layers to form a depot. The drug is released slowly into the systemic circulation via small blood vessels within the dermis. Fat tissue should not impair release, as the drug is released directly from the skin into the blood supply.^[2,5]

Furthermore, fentanyl exhibits wide tissue distribution to the lungs, kidneys, heart, spleen, brain, muscles, and body fat -- indicating a high extravascular volume of distribution (3-8 L/kg). It takes about 6 days to reach steady-state plasma concentrations after initiating fentanyl patch therapy.^[5]

^{Reference 5:}

Muijsers BBR, Wagstaff AJ. Transdermal fentanyl: an updated review of its pharmacological properties and therapeutic efficacy in chronic cancer pain control. Drugs. 2001;61:2289-2307. Abstract

Learn Something New qD: Methadone and Verapamil are Structurally Similar

2014-01-23T12:04:00.000-07:00

English: Synthesis of methadone Deutsch: Synthese von Methadon (Photo credit: Wikipedia)

structural formula of Verapamil (Photo credit: Wikipedia)

In a new series at OncoPRN, look for unique facts in the world of medications, oncology and palliative care.

From Medscape:

"Methadone appears to have a molecular structure similar to that of verapamil and may exhibit similar cardiac properties, such as calcium channel blockade.^[10] One study demonstrated that methadone, unlike morphine, significantly lowered heart rate in rats (p<0 .05="" span="">^[10]

10 Seyler DE, Borowitz JL, Maickel RP. Calcium channel blockade by certain opioids. Fundam Appl Toxicol 1983;3:536-42.

The potential of methadone to cause adverse effects similar to verapamil must be taken under consideration clinically in any patient taking methadone or is to start methadone.

No More Needles? 7 Ways Scientists are Attempting to Move Beyond Shots (TED Blog)

2014-01-16T17:07:00.001-07:00

No more needles? 7 ways scientists are attempting to move beyond shots | TED Blog:

A shot through a puff of air

"In 2012, Jack You of Seoul National University unveiled a device that delivers drugs through a laser pulse. The pulse lasts 250 millionths of a second and, through a series of reactions described on Phys.org, creates a narrow jet of medicine that is just larger than the width of a human hair. “The impacting jet pressure is higher than the skin tensile strength and thus causes the jet to smoothly penetrate into the targeted depth underneath the skin,” explains Yoh. This device is intended to get medicine to the epidermal level."

Full article link: click here

TED - ideas worth sharing!

Final Exit: This doctor sees death daily – but should he help suffering patients end their lives?

2013-12-15T11:34:00.001-07:00

Cover of Final Exit

Final Exit: This doctor sees death daily – but should he help suffering patients end their lives?: "Now, as his province sits poised to legalize doctor-hastened death, Borod raises a blunt question: Would euthanasia, a lethal injection that would have abruptly stopped her breathing and her heart – a step far more aggressive than the “palliative sedation therapy” he had administered – have been more humane?"

Full article: click here

Are 'Super-Enhancers' The Key to Cancer Therapy?

2013-12-06T10:05:00.001-07:00

Image via CrunchBase

Will Newly Discovered 'Super-Enhancers' Allow Us to Control Genes? - The Doctor's Channel:

"Nancy Simonian, MD, CEO, Syros Pharmaceuticals elaborates on the breakthrough discovery of super-enhancers, large groups of transcriptional enhancers that drive expression of genes that define cell identity. "

Link to video here.

Oncology Professional Rebels Network

Prescription Opioids Available in Canada

Virtual Conference: CAPhO's Oncology Fundamentals Day October 1, 2016

Losing That Restless Feeling: Drug-Induced Akathisia Treatment Options

Akathisia

Assessment Scales

Suggested Approach

Opioids Available in Canada

Medical Marijauna: All Formulations Now Legal; Cannabis Harms Brain, Fails in Cancer Pain Study

GW Pharma's cannabis drug [Sativex] fails in cancer pain study, shares fall (via Reuters)

Expired Medications: Drugs past the "best before date" may lose potency, but how soon?

Opioid Tapering Guidelines

eLearning: Lancet Oncology Podcasts

"Palliative Care" - The Words We Use

Related articles

Palliative Care: Better Early Than Late

Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Clinical Practice Guideline

"Cancer: The Emperor of All Maladies" Preview at AACR Annual Meeting 2014

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Video: Healthcare Professionals on Twitter: Worldwide Growth Mapped 2006-2014

Valproic Acid Linked with Reduced Risk of Developing Head and Neck Cancer

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Treating ‘phantom limb pain’ with mirror therapy - Mirror Box Therapy

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The WPCA - Global Atlas of Palliative Care

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VTE Treatment and Secondary Prevention in Cancer Patients

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Personalized Cancer Treament, From Just a Blood Sample

Medications Can Affect Sexes Differently

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Could Electronically Controlled Drugs Reduce Adverse Effects? (CNET)

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Fentanyl Transdermal Patch Application Sites

Learn Something New qD: Methadone and Verapamil are Structurally Similar

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No More Needles? 7 Ways Scientists are Attempting to Move Beyond Shots (TED Blog)

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Final Exit: This doctor sees death daily – but should he help suffering patients end their lives?

Are 'Super-Enhancers' The Key to Cancer Therapy?