Supplements & Special Projects
Pain Management
Opioid Analgesics for Persistent Pain in the Older Patient: Part II
Part I of this two-part article, published in the March issue of the Journal, provided information on selected general concepts in opioid therapeutics, including the role of opioids in pain management, treatment of concurrent acute pain, toxicity, and drug-drug interactions. Part II will discuss dosing of opioid analgesics, pharmacogenomics, and the individual agents.
Dosing of Opioid Analgesics
Due to space limitations, this dosing section will focus only on opioid-to-opioid switch therapy (also called “opioid rotation”), breakthrough pain (BTP) management, and methado
Opioid Analgesics for Persistent Pain in the Older Patient: Part I
Introduction
The opioid analgesics are among the oldest of drugs in use today, with evidence of use dating back thousands of years. These agents mimic the endogenous opioid peptides and act by reducing neuronal excitability (by hyperpolarizing the neuron via enhancement of potassium ion influx) and inhibiting neurotransmitter release (by reducing calcium ion influx). Their effects are mediated by binding to specific receptors in the central and peripheral nervous systems (Table I).1
In this two-part article, some general concepts underlying the use of opioid analgesics
CME Article: Pain Management at the End of Life
Educational Objectives
1. To appreciate the barriers to optional pain management at the end of life
2. To understand the importance of assessment and reassessment of pain for patients at the end of life
3. To be knowledgeable of the unique approaches to assessment and management of pain in the elderly
4. To be able to utilize the Three-Step Analgesic Ladder approach of the World Health Organization in the management of pain at the end of life
ACCREDITATION
The Johns Hopkins Universi
Hallucinations in Parkinson’s Disease: Approach and Management
Hallucination is defined as “false sensory perception not associated with real external stimuli.” Hallucinations in patients with PD are reported as visual hallucinations in 30%,1 auditory hallucinations in 10%,2 and, rarely, tactile hallucinations.3
Visual hallucinations experienced by patients with PD are complex. They occur when the patients are awake and alert,2,4 as opposed to hypnogogic hallucinations. Hallucinations can occur at any time of the day or night, but are more common at nighttime. Initially, patients may be aware of the nonreality of these experiences but gradually bec
Post-Stroke Depression
Psychiatric Complications of Stroke
Many of the studies addressing post-stroke depression (PSD) have arrived at different conclusions. Pseudodepressive mood disorders are often classified simply as depression.
These pseudodepressive manifestations, which occur shortly after a stroke, include emotionalism, catastrophic reaction, pathological crying, anxiety, apathy, and loss of psychic self-activation.4
Some of the studies lump together acute and chronic complications of stroke; for example, mania or mania-like states and catastrophic reactions are seen early in the course of stroke, w
Evaluation and Treatment of Depression in Patients with Cognitive Impairment
This continuing medical education activity is sponsored by the Johns Hopkins University School of Medicine, Baltimore, Maryland. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
These examination questions are based on the article “Evaluation and Treatment of Depression in Patients with Cognitive Impairment,” which appears on pages 39-45 in this issue of Clinical Geriatrics.
Accreditation
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Contin
Anorexia Nervosa in an Older Woman: Eating Disorders as Chronic Conditions
Case Presentation
A 68-year-old widowed woman was referred to a psychologist for counseling by her primary care physician. The physician was concerned that Mrs. R was dieting and exercising excessively. Mrs. R is a nurse who retired two years ago. She moved to an assisted living facility one year ago following the death of her husband. Mrs. R has two daughters who live nearby. She was referred to both a psychiatrist and psychologist many times, but refused to see them. Her daughter convinced her to see a psychologist and came with her to the appointment.
Mrs. R arrived early for her appo
Using a Cognitive Behavioral Therapy Group to Treat Depression and Anxiety in Older Adults
Case Presentation
A 71-year-old married man was seen regularly by his geriatric physician for hypertension, irritable bowel syndrome, depression, and anxiety. He requested frequent medical appointments and always came prepared with a list of questions about his health. His anxiety increased when he read about his conditions and medications in medical guides and on the Internet. He had been given several trials of antidepressants, but perceived intolerable side effects from each. His physician referred him to a cognitive behavioral therapy (CBT) group for treatment of depression and anxiety.
Treatment Algorithms and Management Options for Psoriasis and Psoriatic Arthritis
Psoriasis affects approximately 2.1% of U.S. adults,
up to 7.5 million people, of whom about 30% will develop psoriatic arthritis.
Click here for the latest clinical information on treating your patients with psoriasis.
Clinical Geriatrics Blogs
Coming in Future Issues of Clinical Geriatrics
Series: Diabetes in the Elderly
Series: Cancer in Older Adults
First Report® Conference Coverage: American Academy of Neurology, American Diabetes Association, 2010 Digestive Disease Week
Assessment and Classification of Pain in the Elderly Patient
Pharmacologic Management of Pain in Older Patients
Miscellaneous Pain Syndromes in Older Adults
Nonhernia Causes of Inguinal Pain in the Elderly
