OxyContin (controlled-release oxycodone hydrochloride) (Purdue Pharma, Stamford, CT) was approved in 1995 by the US Food and Drug Administration (FDA) for moderate-to-severe chronic pain. Crushing and snorting the delayed-release tablets results in a rapid release of the drug, increased absorption, and high peak serum concentrations. The propensity for addiction to OxyContin and the trend of increased prescription drug abuse have made it imperative for physicians and health care providers to recognize the clinical presentation of overdose and know how to manage associated complications.
In this review of OxyContin, we discuss current trends in its abuse and the clinical presentation of overdose. We review the specific effects of the drug on body systems and the recognition of symptomatology, differential diagnosis, and management.
Many of the clinical findings in acute opioid overdoses are nonspecific, making diagnosis difficult. OxyContin overdose presents with a typical opiate toxidrome, including decreased respirations, miosis, hypothermia, bradycardia, hypotension, and altered mental status. The presence of coingestants can cloud the clinical picture. If OxyContin overdose is suspected, early ventilation and oxygenation should be administered, which is generally sufficient to prevent death. Even in the absence of a confirmation, cautious administration of naloxone--the opiate receptor antagonist and antidote for opioid overdoses--may have both diagnostic and therapeutic effects.
With increasing rates of prescription drug abuse, OxyContin will continue to present challenges to physicians and health care providers. Physicians should be aware of potential patients who are seeking OxyContin for recreational use.
[Show abstract][Hide abstract] ABSTRACT: In monopulse radar systems, the situation of merged measurements from closely-spaced targets results in angle-of-arrival (AOA) estimates that may be far from any of the actual targets. A monopulse processing technique for estimating the direction-of-arrivals (DOAs) for two unresolved targets from corrupted monopulse measurements was recently developed for a single angular coordinate. In this paper, that technique for DOA estimation for two Rayleigh target is extended to two angular coordinates. A procedure for incorporating possibly merged measurements into an optimal 2-D measurement-to-track assignment algorithm is developed for the case of idealized resolution (i.e., either targets are completely resolved or the measurements are fully merged). Simulation results of the new algorithm will be presented to show the improved data association performance.
[Show abstract][Hide abstract] ABSTRACT: This study aims to evaluate the prescription patterns and side effects of oxycodone in a local hospital setting.
This is a retrospective analysis of all patients who were prescribed oxycodone for acute or chronic pain from June to November 2007. Patients' names were obtained from the hospital pharmacy and data were collected with a set of questionnaire after review of their casenotes. Prescription was compared with other recommended opioid prescription guidelines. Side effects to oxycodone use were documented.
One hundred and thirty patients were prescribed oxycodone for the 6-month study period. Prescription by the orthopaedic surgeons was the highest, followed by the pain service. Most patients had a clear indication for use of oxycodone and appropriate dosing regimes. However, two thirds of the patients prescribed oxycodone were not reviewed with regard to their analgesia within 24 hours and one third did not have titration of the drug to their pain symptoms. Majority of the patients had outpatient follow-up within 4 weeks of discharge. Common side effects included nausea, vomiting and constipation.
This is the first local audit that profiles oxycodone prescription patterns and its side effects. Prescription of oxycodone was appropriate for the majority of the study population. Patient assessment upon initiation of oxycodone therapy and titration of the drug to patients' pain symptoms was suboptimal. Oxycodone was well tolerated by the study population with minimal side effects. Further quality measures and ongoing education of clinicians will ensure future patients obtain safe and effective analgesia.
Annals of the Academy of Medicine, Singapore 11/2009; 38(11):947-51. · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Oxycodone is a semisynthetic opioid analgesic largely prescribed for post-operative and chronic pain management. The introduction of a slow release formulation of oxycodone has led to its frequent abuse and to an increase in emergency cases related to oxycodone overdose. Until recently, oxycodone testing has been confined to gas chromatography-mass spectrometry (GC-MS) analysis because the widely used automated opiate immunoassays poorly react to this compound. We investigated the utility of a new oxycodone immunoassay as a screening procedure to eliminate inappropriate GC-MS testing of negative urine specimens. We analyzed 96 urine specimens using GC-MS and two immunoassays, CEDIA((R)) opiates and DRI((R)) oxycodone assays from Microgenics, on a Hitachi 917 analyzer. The GC-MS allowed us to detect codeine, hydrocodone, hydromorphone, morphine, oxycodone, and oxymorphone following enzymatic hydrolysis and derivation by acetylation. The combination of the two immunoassays gave the best performance (98% sensitivity and specificity) when considering a positive result from GC-MS for any of the opiates. Considering positive GC-MS results for oxycodone or oxymorphone only, the oxycodone immunoassay resulted in two false-positives and one false-negative (50 ng/mL cutoff). Using these immunoassays for screening before GC-MS analysis provides a reduced opiate GC-MS workload without compromising quality.
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