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Biomedical subjects

Eric Prommer

Publications and source records attributed to Eric Prommer.

14 recordsLinked to original sources
PubMed2006

Levorphanol: the forgotten opioid.

BACKGROUND: Levorphanol (levo-3-hydroxy-N-methylmorphinan) is a strong opioid that is the only available opioid agonist of the morphinan series. Levorphanol was originally synthesized as a pharmacological alternative to morphine more than 40 years ago. It is considered a step-3 opioid by the World Health Organization (WHO) and has a greater potency than morphine. Analgesia produced by levorphanol is mediated via its interactions with mu, delta, and kappa opioid receptors. Levorphanol is also an N-methyl-D-aspartate (NMDA) receptor antagonist. There is evidence that levorphanol may inhibit uptake of norepinephrine and serotonin. Similar to morphine, levorphanol undergoes glucuronidation in the liver, and the glucuronidated products are excreted in the kidney. Levorphanol can be given orally, intravenously, and subcutaneously. OBJECTIVE: This article reviews the pharmacodynamics, pharmacology, and clinical efficacy for this often overlooked step-3 opioid. CONCLUSION: The long half-life of the drug increases the potential for drug accumulation. Levorphanol has clinical efficacy in neuropathic pain.

Administration, Oral↗
PubMed2006

Ziconotide: a new option for refractory pain.

Ziconotide has been introduced as a new nonopioid treatment for chronic pain. Structurally, it is a peptide, the synthetic analog of the omega-conotoxin, derived from the marine snail, Conus magus. N-type voltage-sensitive calcium channels play a role in the transmission of nociceptive stimuli and also are involved in the release of neurotransmitters important in pain transmission. Ziconotide's therapeutic benefit derives from its potent and selective blockade of neuronal-type voltage-sensitive calcium channels. Blockade of the channels results in suppression of abnormal ectopic discharges from the injury site or the dorsal root ganglia, possibly resulting in decreased neuroplasticity, and decreased synaptic transmission that leads to the generation of chronic pain syndromes. The advantage of ziconotide is that tolerance does not occur, while disadvantages associated with ziconotide are the need for intrathecal administration and significant neurotoxicites associated with its use. When tested in clinical trials, ziconotide has been shown to have synergistic or additive value to the effect of morphine. Ziconotide, formerly known also as SNX- 111, represents a new class of agents, the N-type calcium channel blockers. These may represent another option for patients with refractory pain and refractory pain syndromes.

Analgesics, Non-Narcotic↗
PubMed2005

Oxymorphone: a review.

Oxymorphone (oxymorphone hydrochloride) (14-hydroxy-dihydromorphinone), a semisynthetic mu-opioid agonist, was first approved by the US Food and Drug Administration in 1959. Oxymorphone is considered a more potent opioid than its parent compound, morphine. Recently, an immediate-release and long-acting oral formulation of this drug was developed that makes oxymorphone a new option in treating moderate to severe pain. This article reviews the pharmacodynamics, pharmacology, and clinical efficacy for this new option in treating moderate to severe pain.

Analgesics, Opioid↗
PubMed2005

Management of bleeding in the terminally ill patient.

Clinically significant bleeding occurs in approximately 6%-10% of patients in the palliative-care setting. Bleeding can range from persistent and small in quantity (but enough to interfere with a patient's quality of life), to catastrophic bleeding that ultimately leads to the rapid demise of the patient. Uncontrolled bleeding can be very distressing for staff, patients and families. Advanced planning is necessary in all bleeding circumstances. This session will review the types of cancer associated with bleeding, as well as management options for these situations. Emphasis will be placed on aspects of communication with families.

Advance Care Planning↗
PubMed2005

Aprepitant (EMEND): the role of substance P in nausea and vomiting.

Aprepitant (EMEND) is the first commercially available drug from a new class of agents, the Substance P/neurokinin NK-1 receptor antagonists. Aprepitant is indicated for prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV) associated with highly emetogenic chemotherapy in adults. Its ability to antagonize the effects of Substance P has lead to greater understanding of the pathophysiology of nausea and vomiting. Its broad range of activity against a wide variety of central and peripheral emetogenic stimuli make it potentially useful in non-chemotherapy related nausea and vomiting.

Animals↗
PubMedDate not supplied

Gefitinib: a new agent in palliative care.

In 2003, gefitinib (Iressa, AstraZeneca, London, UK) in 250 mg tablet form received accelerated approval by the US Food and Drug Administration. Gefitinib targets the cancer cell at the molecular level and has the ability to palliate lung cancer symptoms. Gefitinib's ability to control symptoms with minimal toxicity provides physicians with a new option to complement current symptom control methods. It is nonmarrow suppressive and seems to have an ability to control symptoms quickly, even in the absence of obvious tumor reduction. However, further studies are needed to compare gefitinib's ability to control symptoms with intensive palliative modalities for lung cancer, such as opioids, oxygen, and radiation therapy.

Antineoplastic Agents↗