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Use of lidocaine and mexiletine for refractory pain syndromes

Description:

Pain, palliative care and hospice (PPCH) teams specialize in providing whole person care for patients diagnosed with serious medical illnesses.  There are a set of step-wise approaches that multidisciplinary palliative care teams utilize in their assessment and treatment of complex pain.  When initial treatment approaches are not successful, PPCH pharmacists are often asked to lead treatment of these refractory cases with their expertise in medication pharmacology in the setting of inadequate supporting literature.  In this session we will discuss a case to highlight refractory total pain and promote the use of lidocaine infusion for refractory pain syndromes and conversion of lidocaine to mexiletine for home use.  

Learning Objectives:

  1. Discuss transitioning complex inpatient treatment approaches to a feasible discharge plan.  
  2. Discuss use of lidocaine refractory pain syndromes and conversion to mexiletine.

Faculty:

  • Rabia Atayee
  • Kyle Edmonds

 

Leaving the reflexive groan at the door:  Giving pain management and palliative care teams the skills and tools to advocate for patients with sickle cell disease

Description:

Sickle cell disease (SCD) is the most common inherited blood disorder in the United States, affecting approximately 100,000 Americans. Despite the fact that medical advances are ensuring that those with SCD are living longer, their quality of life is not necessarily improved and the care they receive is inconsistent.  As a result, caring for these people is often a complex and challenging task for most providers and it can elicit a reflexive ?groan? from even the most caring team members.  Pain management and palliative care teams are increasingly being asked to help care for people with SCD.  Pharmacists on these teams have the capacity to guide optimal care, inform and educate healthcare providers and patients, assess and recommend pertinent interventions, and ultimately optimize the quality of life of the sickle cell patients they encounter. This session would aim to provide an overview of sickle cell disease and common causes of morbidity and mortality. Additionally, it will focus on unique complexities of this patient population and opportunities for the pain management and palliative care provider to optimize quality of life. 

Learning Objectives:

  1. Describe sickle cell disease and the most common causes of morbidity and mortality in this patient population
  2. Summarize the unique complexities of sickle cell disease treatment and opportunities to optimize patient care via pain management and palliative care interventions

Faculty:

  • Rabia Atayee
  • Stephanie Abel

 

The emperor has no clothes: The evidence behind reduced doses of acetaminophen in chronic hepatic dysfunction  

Description:

Professional organization and contemporary review articles contain varying recommendations for optimal acetaminophen dosing in cirrhosis patients.   This has resulted in inconsistent acetaminophen prescribing practices.  The goal of our session is to review the evidence supporting reduced acetaminophen dosing in cirrhosis patients.  

Learning Objectives:

  1. Review the evidence supporting reduced acetaminophen doses in cirrhosis patients.
  2. Apply the clinical evidence to formulate a patient specific recommendation for use of acetaminophen in cirrhosis. 

Faculty:

  • Katherine Juba, PharmD
  • Anne Schweighardt, PharmD

 

 

Please don't let me suffer or relapse: Managing pain in the recovering addict

Description:

This presentation will expose the fears and concerns of an individual who is in recovery from substance use disorder when facing pain which requires opioid therapy. Recommendations for prescribing protocols and the responsibility of the individual for safeguarding and maintaining their recovery will be highlighted.

Learning Objectives:

  1. Describe action plans which a recovering individual might use to prevent relapse when facing the need to take opioids.
  2. List considerations for prescribing and monitoring for individuals who are recovering addicts and  who require opioids.

Faculty:

  • Phyllis Grauer, PharmD

 

Minimizing the impact of parenteral opioid shortages

Description:

Supplies of parenteral hydromorphone, fentanyl, and morphine have becoming increasingly scarce. This activity will describe ongoing challenges related to the current nationwide shortage of parenteral opioids.  It will identify best practices for minimizing the impact of drug shortages and focus on the use of two available opioids, nalbuphine and buprenorphine. Pharmacologic/pharmacokinetic characteristics, advantages, and disadvantages of these agents will be discussed.

Learning Objectives:

  1. Explain recent trends related to the shortage of parenteral opioids 
  2. Identify best practices and possible alternatives to mitigate the impact of parenteral opioid shortages.

Faculty:

  • Ryan Costantino
  • Alexandra McPherson

 

Illicit Fentanyl: Revealed

Description:

Synthetic opioid derivatives of fentanyl, such as carfentanil, are emerging public health threats. Illicit fentanyl derivatives are often present in counterfeit prescription opioids or marketed as ?super potent? heroin. According to the CDC, from 2014 to 2015, drug overdose deaths increased by 5,349 (11.4%), signifying a continuing trend observed since 1999 and these increases in death rates were driven by synthetic opioids other than methadone (72.2%), most likely illicitly-manufactured fentanyl, and heroin (20.6%). The CDC also reports that during 2014?2015, rates of natural/semisynthetic opioid deaths increased among males overall, both sexes aged 25?44 years, and non-Hispanic whites. In response to the laced-heroin epidemic, expansion of naloxone use is a key role in combating this epidemic. It is important to be aware that some patients may require higher than usual amounts of naloxone to reverse illicit fentanyl effects. Best practices will be reviewed including lessons learned as described by the New Haven office of emergency management. Clinical pearls will be provided for implementation into your local practice site. 

Learning Objectives:

  1. Identify the illicit trade routes and risks of illicit fentanyl laced heroin    
  2. Describe best practices in response to illicit fentanyl overdoses

Faculty:

  • Sandra DiScala

 

 

 


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