Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Temozolomide is an oral alkylating agent used in the treatment of metastatic melanoma. Commonly reported adverse effects of the drug include nausea and vomiting, constipation, headache, and fatigue, as well as myelosuppression, which may be dose limiting. Few reports have described dermatologic adverse effects such as rash and pruritus, and, to our knowledge, none have discussed the seriousness or extensiveness of the rash. We describe a 37-year-old woman who was receiving temozolomide for treatment of metastatic melanoma. After 6 weeks of therapy, the patient developed an unexplained fever. The drug was discontinued, and the fever resolved within 2 days. Temozolomide was restarted 2 months later; the patient again developed a fever. This time the fever was accompanied by a diffuse erythematous skin rash that progressed to an extensive, full-body, desquamative skin rash. The rash was treated with moisturizing cream along with intravenous and topical corticosteroids and antibiotics. Due to the severity of the rash, temozolomide was permanently discontinued. Even after its discontinuation, the patient experienced the rash on a long-term basis, with periodic exacerbations. However, none were as severe as the first rash. The patient's metastatic disease remained stable for the next 2 years. According to the Naranjo adverse drug reaction probability scale, the likelihood that temozolomide was responsible for the adverse drug reaction of fever was probable (score of 6). Clinicians should be aware that an erythematous and exfoliative rash may be induced by temozolomide, and be familiar with the pharmacologic and supportive measures necessary for its treatment.
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PMID:Temozolomide-induced desquamative skin rash in a patient with metastatic melanoma. 1829 21

Up to 70% of cancer patients in the terminal phase of their disease complain of moderate or severe pain. Pain therapy in these patients follows the analgesic ladder of the WHO. Many cancer patients will need a strong opioid to get sufficient pain relief. Fentanyl-TTS (transdermal therapeutic system) may be a new alternative for chronic pain therapy in cancer patients. Analgesic rates of fentanyl are released from the patch over a period of 72 h. After application, peak serum concentrations of fentanyl are measured after 8-16 h. Serum half-life time is prolonged (16-21 h) because of the intradermal depot of fentanyl. The efficacy of Fentanyl-TTS in pain therapy for cancer patients was demonstrated in clinical studies, which showed a good analgesic effect over a long period of time. Like the chronic therapy of cancer pain with conventional opioid routes, dose escalation was necessary in most patients. In most studies the application of another opioid in a second route of application was necessary as a rescue medication. During therapy of cancer pain with Fentanyl-TTS, 3 of 246 patients developed a bradypnea (respiratory rate <10/min). In contrast, respiratory depression in chronic cancer pain was never reported when the opioid was administered orally or regionally and when technical faults were excluded. The side effects during therapy with Fentanyl-TTS were those accompanying chronic opioid therapy (constipation, vomiting, nausea). The patch was well tolerated by the skin. Local side effects were minor (erythema, pruritus, pustules) and disappeared within a few hours after removal of the patch. The transdermal application of a strong opioid may be an alternative, especially for patients with cancer of the head and neck or in the gastrointestinal tract. Because of the pharmacokinetic laziness of the system the use of Fentanyl-TTS should be limited to patients with stable tumor pain. In these patients Fentanyl-TTS might be valuabe on step III of the analgesic ladder of the WHO or as an alternative to invasive methods when it is impossible to administer oral opioids.
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PMID:[Transdermal fentanyl for the treatment of cancer pain.]. 1841 15

Pain is among the worst possible experiences for the critically ill. Therefore, nearly all intensive care patients receive some kind of pain relief, and opioids are most frequently administered. Morphine has a number of important adverse effects, including histamine release, pruritus, constipation, and, in particular, accumulation of morphine-6-glucuronide in patients with renal impairment. Hence, it is not an ideal analgesic for use in critically ill patients. Although the synthetic opioids fentanyl, alfentanil, and sufentanil have better profiles, they undergo hepatic metabolism and their continuous infusion also leads to accumulation and prolonged drug effects. Various attempts have been made to limit these adverse effects, including daily interruption of infusion of sedatives and analgesics, intermittent bolus injections rather than continuous infusions, and selection of a ventilatory support pattern that allows more spontaneous ventilation. However, these techniques at best only limit the effects of drug accumulation, but they do not solve the problem. Another type of approach is to use remifentanil in critically ill patients. Remifentanil is metabolized by unspecific blood and tissue esterases and undergoes rapid metabolism, independent of the duration of infusion or any organ insufficiency. There are data indicating that remifentanil can be used for analgesia and sedation in all kinds of adult intensive care unit patients, and that its use will result in rapid and predictable offset of effect. This may permit both a significant reduction in weaning and extubation times, and clear differentiation between over-sedation and brain dysfunction. This article provides an overview of the use of short-acting opioids in the intensive care unit, with special emphasis on remifentanil. It summarizes the currently available study data regarding remifentanil and provides recommendations for clinical use of this agent.
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PMID:The place for short-acting opioids: special emphasis on remifentanil. 1849 56

The recent approval by the US Food and Drug Administration of 2 medications--methylnaltrexone and alvimopan--introduces a new class of therapeutic entities to clinicians. These peripherally acting mu-opioid receptor antagonists selectively reverse opioid actions mediated by receptors outside the central nervous system, while preserving centrally mediated analgesia. Methylnaltrexone, administered subcutaneously, has been approved in the United States, Europe, and Canada. In the United States, it is indicated for the treatment of opioid-induced constipation in patients with advanced illness (eg, cancer, AIDS) who are receiving palliative care, when response to laxative therapy has not been sufficient. Alvimopan, an orally administered medication, has been approved in the United States to facilitate recovery of gastrointestinal function after bowel resection and primary anastomosis. Clinical and laboratory studies performed during the development of these drugs have indicated that peripheral receptors mediate other opioid effects, including decreased gastric emptying, nausea and vomiting, pruritus, and urinary retention. Laboratory investigations with these compounds suggest that opioids affect fundamental cellular processes through mechanisms that were previously unknown. These mechanisms include modifications of human immunodeficiency virus penetration, tumor angiogenesis, vascular permeability, and bacterial virulence.
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PMID:Development of peripheral opioid antagonists' new insights into opioid effects. 1882 66

Albendazole binds to parasite's tubulin inhibiting its glucose absorption. Its common adverse effects are nausea, vomiting, constipation, thirst, dizziness, headache, hair loss and pruritus. Although mainly metabolized in the liver, abnormal liver function tests were a rare adverse effect during clinical trials and we found no literature about albendazole-induced hepatitis requiring admission. This patient had a previous history of albendazole ingestion in 2002 resulting in increase of liver function tests. And in 2005, the episode repeated. We evaluated the patient for viral hepatitis, alcoholic liver disease, and autoimmune hepatitis, but no other cause of hepatic injury could be found. Liver biopsy showed periportal steatosis and periportal necrosis. The initial abnormal liver function test improved only with supportive care. These findings and the Roussel Uclaf Causality Assessment Method of the Council for International Organizations of Medical Sciences (RUCAM/CIOMS) score of 9 are compatible with drug-induced hepatitis so we report the case of this patient with a review of the literature.
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PMID:Acute drug-induced hepatitis caused by albendazole. 1895 2

Varicose veins are twisted, dilated veins most commonly located on the lower extremities. Risk factors include chronic cough, constipation, family history of venous disease, female sex, obesity, older age, pregnancy, and prolonged standing. The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure. A heavy, achy feeling; itching or burning; and worsening with prolonged standing are all symptoms of varicose veins. Potential complications include infection, leg ulcers, stasis changes, and thrombosis. Some conservative treatment options are avoidance of prolonged standing and straining, elevation of the affected leg, exercise, external compression, loosening of restrictive clothing, medical therapy, modification of cardiovascular risk factors, reduction of peripheral edema, and weight loss. More aggressive treatments include external laser treatment, injection sclerotherapy, endovenous interventions, and surgery. Comparative treatment outcome data are limited. There is little evidence to preferentially support any single treatment modality. Choice of therapy is affected by symptoms, patient preference, cost, potential for iatrogenic complications, available medical resources, insurance reimbursement, and physician training.
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PMID:Management of varicose veins. 1906 22

This article describes the signs for suspecting neoplasia that lead the patient to come to the Accident and Emergency Service, concentrating on genital bleeding, pelvic mass and vulvar pruritus. Patients can also come due to processes resulting from complications of the disease, such as urethral obstruction, carcinomatosis, ascites, thromboembolic processes, haemorrhages, constipation, nausea and vomiting, intestinal obstruction and pain. Finally, we describe complications that are secondary to the treatment, such as abdominal and inguinal lymphocele and post-radiotherapy enteritis and proctitis.
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PMID:[Emergencies in oncological gynaecology]. 1943 35

In April 2008, the US FDA granted approval to methylnaltrexone (Relistor), the first peripheral micro-opioid-receptor antagonist for the treatment of opioid-induced constipation in advanced-illness patients receiving palliative care and for whom other laxative therapies failed to achieve adequate results. Methylnaltrexone, a quaternary derivative of naltrexone, introduces a novel mechanism of action that selectively antagonizes the peripheral micro-receptors in the GI tract without effects on the CNS. In clinical trials, subcutaneous methylnaltrexone reversed opioid-induced constipation after the first dose in approximately 50-60% of the patients. In most of the cases, effective laxation occurred within 1 h. The therapeutic benefit was sustained in multiple-dose studies. Owing to the nature of the population studied, safety data are available for approximately 4 months of use. Although it is not the focus of this article, methylnaltrexone's mechanism of action suggests it could be beneficial for other peripheral, opioid-induced adverse effects, such as opioid-related nausea, vomiting, urinary retention, pruritus or postoperative ileus.
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PMID:Methylnaltrexone: a novel approach for the management of opioid-induced constipation in patients with advanced illness. 1981 69

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide, causing about 1 million deaths annually. Patients with HCC usually reported multiple concurrent symptoms. The purpose of this multivariate study was to explore whether multiple concurrent symptoms are clustered into groups of symptoms and to explore the effect of symptom clusters on the quality of life (QOL) in patients with HCC. A sample of 180 patients with HCC at a medical center in Korea was recruited. Patients completed a demographic questionnaire, a Symptom Checklist, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-Hepatobiliary. Factor analysis was used to identify symptom clusters based on the severity of patients' symptom experiences. Four symptom clusters were identified: pain-appetite, fatigue related, gastrointestinal, and itching-constipation. Two patient subgroups were identified through cluster analysis: high- and low-symptom group. Patients in the high-symptom group had significantly poorer functional status and poorer QOL in all the domains, with the exception of social well-being. The differences between the 2 patient subgroups were not only statistically but also clinically significant. Patients in the high-symptom group were also statistically and clinically anxious and depressed. Further research is needed to explore whether compositions of symptom cluster phenotypes vary over time and whether the associations of symptom clusters with QOL and mood are changing along the disease and treatment trajectory as well as symptom status.
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PMID:Symptom clusters and quality of life in Korean patients with hepatocellular carcinoma. 1992 81

The introduction of minimally invasive total knee arthroplasty has been accompanied by substantial changes in anesthesia and analgesia techniques. It is well recognized that the goals of minimally invasive surgery, which include rapid rehabilitation and improved patient function, cannot be achieved without excellent postoperative analgesia. Traditional postoperative pain management has been associated with high rates of suboptimal pain control, however. The conventional options for early postsurgical pain management include indwelling epidural catheters, which require changes in postoperative prophylaxis for thromboembolism, and patient-controlled analgesia pumps, which are associated with fluctuating pain levels and inconsistent pain relief. Numerous adverse effects are associated with traditional opioid medications, including respiratory depression, urinary retention, nausea, sedation, constipation, and pruritus. Safe, effective, and well-tolerated early pain relief after a minimally invasive knee replacement can be accomplished using a multimodal oral pain regimen, peripheral nerve blocks, and local injections.
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PMID:Contemporary pain management strategies for minimally invasive total knee arthroplasty. 2041 73


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