Tuesday, September 28, 2010

Hockey — Not Cancer — On Henderson’s Mind: Anniversary Of THE Goal

Canadian hockey player Paul Henderson (center, dark jersey) shoots on net during the 1972 Summit Series between Team Canada and Team USSR, Canada, September 1972. The Soviet defense is provided by goalkeeper Vladislav Tretiak and Yevgeny Poladiev (number 26). Henderson went on the score the series-winning goal for Canada in the eighth game. (Photo by Hulton Archive/Getty Images)

Here's a synopsis of my timely post today at The Hockey Writers.

Either I have forgotten or somehow the news eluded me when announced back in February, but Hockey Canada legend (a term which is probably used too loosely in the sports world, but not in this case) Paul Henderson was then diagnosed with CLL (Chronic Lymphocytic Leukemia).

Today (September 28th) marks the 38th anniversary of his historic and dramatic series clinching goal in the ’72 Summit Series, and it was great to hear Mike Richards in the Morning ( interview him today.

Henderson told CBC Sport back in February:
“In Canada, they wait for significant pain before starting chemotherapy,” he says. “It could be one year, two years, even three years.

Paul Henderson - Lucknow Mural {Flickr/Pampered Paws}

“I’m looking for alternative treatments, which are more prevalent in Europe.”
According to Henderson, the disease is in Stage Four. It is in his stomach. His chest. His blood. His lymph nodes. Eventually it will cause his body to decay. But not his spirit, he vows. Never his spirit.
“I have no fear, no angst,” he says. “There is no ‘Why me?’ After all, who has lived a greater life than me?
“I have a loving wife, kids, grandkids. I feel great. I work out five times a week. I can walk 36 holes of golf — at least I could in the fall.
“I always said I would live life to the fullest until the day I died. I just didn’t expect to die this soon,” he says with a laugh.
 Read on by clicking on the following link and recapture some of the great moments in Canada sports history and catch up with Paul Henderson:


Friday, September 10, 2010

Monoclonal Antibody Nomenclature've just genetically engineered the latest and greatest MAB and want to give it the creative and unique name it deserves. Well...there are rules about naming such things which must be followed:

• ‘mab’ = monoclonal antibody

• Syllable directly before - humanized, chimeric, etc.

• Prefix = no meaning

• Second syllable = Where the Ab works

Letters - Target - Letters - Origin

Ci (r) - Cardiovascula -a- Rat

Tu (m) - Tumor -o- Mouse

Li (m) - Immune -xi- Chimeric human/mouse

Co (l) - Colon Tumor -zu- Humanized

Me (l) - Melanoma -u- Human

Go (v) - Ovarian Tumour -axo- Rat/murine hybrid

Pr (o) - Prostate



Wednesday, September 8, 2010

Fixed combination of oxycodone with naloxone: a new way to prevent and treat opioid-induced constipation

Courtesy of Peerview Institute:

Adv Ther. 2010 Sep;27(9):581-90. Epub 2010 Aug 11.

Mueller-Lissner S.

Park-Klinik Weissensee, Schönstrasse 80, 13086 Berlin, Germany.


Morphine and other opioids increase tone and reduce propulsive motility in several segments of the gut, enhance absorption of fluids, and inhibit secretion. This opioid-induced bowel dysfunction may present as infrequent stools, hard stools, difficult defecation, bloating, and sense of incomplete emptying of the bowels, but also dry mouth, gastroesophageal reflux, epigastric fullness, and abdominal cramping. It afflicts about one-third of patients on opioid treatment. Lifestyle measures, such as regular toilet visits, physical activity, and fiber-rich diet, are very unlikely to be successful. Laxatives, such as bisacodyl, sodium picosulfate, sennosides, macrogols, and prucalopride, may relieve opioid-induced constipation (OIC) in a proportion of patients only. A new approach to counteract OIC is the coadministration of an opioid antagonist devoid of the potential to penetrate the brain. In the EU, an oxycodone/naloxone combination has been approved for this purpose. Both components are included in an oral extended-release preparation. Following its release, naloxone acts locally on the gut and antagonizes the inhibitory effect of the opioid. After being absorbed in parallel with oxycodone, naloxone is rapidly and completely inactivated by a high first-pass effect in the liver. In a 2:1 dose ratio it may improve OIC without interfering with the analgesic effect.

PMID: 20714946 [PubMed - in process]


Vitamin D role in preventing aromatase inhibitor-induced arthralgia

Courtesy of

Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort study

Breast Cancer Research and Treatment, 08/04/2010
Exclusive author commentary
Prieto–Alhambra D et al.

Aromatase inhibitor (AI)–associated arthralgia limits adherence to therapy in breast cancer...After supplementation (daily 800 IU and additional 16,000 IU every 2 weeks), 50% of them still failed to reach adequate concentrations at 3 months. In the whole cohort, there was an increase in joint pain and the increase was significantly attenuated in those that reached concentrations of 25(OH)D of > or =40 ng/ml, with a lower risk of incident arthralgia. A target concentration of 40 ng/ml 25OHD may prevent development of AI arthralgia but higher loading doses are required to attain this level in women with deficiency at baseline.

Daniel Prieto-Alhambra (08/05/2010) comments:
Adherence to aromatase inhibitor(AI) therapy is required to improve survival in women with early breast cancer who can be treated with these drugs. AI-induced arthralgia is highly associated with discontinuation. We have shown for the first time that Vitamin D repletion (with target concentrations > or 40ng/ml) might prevent development of joint pain associated with AI therapy, and thus, may improve adherence. A randomized clinical trial is required now to ensure causality."


Tuesday, September 7, 2010

Smoking marijuana relieves some pain: Study

Small marijuana plants, available for sale, are shown in a medical marijuana dispensary in Oakland, California in this June 30, 2010 file photo. California, the U.S. state that first allowed sales of medicinal marijuana in 1996, may take away all restrictions on adult use of the drug in a November vote, giving local governments the option to regulate sales and growing of marijuana. Picture taken June 30, 2010. To match Special Report MARIJUANA/CALIFORNIA REUTERS/Robert Galbraith/Files (UNITED STATES - Tags: AGRICULTURE POLITICS BUSINESS SOCIETY HEALTH)

From CBC:

People who suffer chronic neuropathic or nerve pain from damage or dysfunction of the nervous system have few treatment options with varying degrees of effectiveness and side-effects.

Neuropathic pain is caused by damage to nerves that don't repair, which can make the skin sensitive to a light touch.

Cannabis pills have been shown to help treat some types of pain but the effects and risks from smoked cannabis were unclear.

To find out more, Dr. Mark Ware, an assistant professor in family medicine and anesthesia at Montreal's McGill University, and his colleagues conducted a randomized controlled trial — the gold standard of medical research — of inhaled cannabis in 21 adults with chronic neuropathic pain.

Investigators used three different strengths of the active drug — THC levels of 2.5 per cent, six per cent and 9.4 per cent, as well as a zero per cent placebo.

"We found that 25 mg herbal cannabis with 9.4 per cent THC, administered as a single smoked inhalation three times daily for five days, significantly reduces average pain intensity compared with a zero per cent THC cannabis placebo in adult subjects with chronic post traumatic/post surgical neuropathic pain," the study's authors concluded in Monday's online issue of the Canadian Medical Association Journal.

Read more:

"The authors should be congratulated for tackling such a worthwhile question as: does cannabis relieve neuropathic pain? particularly because the trial must have been a major nightmare to get through the various regulatory hurdles," Dr. Henry McQuay of Balliol College, Oxford University, U.K., said in a journal commentary accompanying the study.

McQuay concluded that the trial adds to the "trickle of evidence that cannabis may help some of the patients who are struggling at present."


Pain & Symptom Management Updates

From the Pharmacist Letter, September 2010:


New Canadian guidelines will clarify how to manage opioid therapy in patients with chronic non-cancer pain.

Opioid use is rising and so are abuse, diversion, and overdoses.

But on the other hand, chronic pain is still often undertreated and can lead to disability, depression, and other problems.

Recommend trying other options first, such as NSAIDs for inflammation, low-dose amitriptyline for neuropathic pain, etc.

Before going to chronic opioids, suggest assessing for substance abuse, getting informed consent, and setting up an opioid agreement.

Use pain severity and functional improvement to guide therapy.

Mild to moderate pain. Suggest codeine or tramadol first...then morphine, oxycodone, or hydromorphone if needed.

Recommend starting with a short-acting opioid...titrating the dose as needed...then switching to a long-acting formulation for maintenance to improve adherence and minimize breakthrough pain.

Suggest BuTrans (buprenorphine) for patients who can benefit from a once-a-week patch for moderate pain.

Severe pain. Recommend starting with morphine, oxycodone, or hydromorphone...and stepping up to fentanyl if needed.

Reserve methadone for the most resistant cases. Keep in mind that physicians need a special exemption to prescribe methadone.

Keep an eye on oral morphine equivalents...most patients can be managed on less than 200 mg/day. At higher doses, re-evaluate for tolerance, abuse, or a new cause for the pain. For help, see our chart, Equianalgesic Dosing of Opioids for Pain Management.

Suggest continuing NSAIDs or acetaminophen if they help.

Caution patients to limit acetaminophen doses. Consider recommending a maximum of just 2.6 g/day...instead of 4 g/ reduce the risk of developing liver toxicity.

Suggest stopping benzodiazepines before starting decrease the risk of sedation and overdose.

Help patients have realistic expectations. Explain that a successful outcome is improving function and reducing pain intensity by about 30%. Also recommend exercise, physical therapy, and adequate rest.

Watch for possible interactions. Oxycodone levels may be increased by 3A4 inhibitors, such as clarithromycin. See our chart, Cytochrome P450 Drug Interactions, for other possible interactions.

View Detail-Document #260909
Tools for risk assessment, patient consent, pain contracts, and monitoring are available at:


Pain Updates: Butrans - Buprenorphine patch

  • is a transdermal system (buprenorphine) indicated for moderate-to-severe chronic pain in patients requiring an around-the-clock opioid analgesic for an extended period of time.
  • exerts its analgesic effect via high affinity binding to μ opiate receptors in the CNS; displays partial mu agonist and weak kappa antagonist activity
  • intended to be used for the continual release of buprenorphine transdermally over a 7-day period per patch, for the management of persistent pain of moderate intensity. BuTrans can be used in either opioid naïve patients or patients previously treated with PRN (as needed) analgesics when the analgesic requirement has progressed to a need for continuous opioid analgesia.
  • Pallimed article:
  • From:
    • Its release is controlled by the physical characteristics of the matrix and is proportional to the surface area of the patch. Absorption of the buprenorphine through the skin and into the systemic circulation is influenced by the stratum corneum and blood flow.
    • There are few practical differences in the use of the buprenorphine or fentanyl matrix patches.
    • Compared with fentanyl, TD buprenorphine adheres better. However, after patch removal, it is associated with more persistent erythema (± localized pruritus), and sometimes a more definite dermatitis.
    • Retrospective analysis suggests that, compared with TD fentanyl, patients receiving TD buprenorphine (as Transtec®) have a slower rate of dose increase and longer periods of dose stability.
    • Buprenorphine does slow intestinal transit, but possibly less so than morphine. Constipation may be less severe.
    • In contrast to other opioids, buprenorphine does not suppress the gonadal axis or testosterone levels.
    • Compared with morphine and other opioids, buprenorphine has little or no immunosuppressive effect.
    • With typical clinical doses, it is possible to use morphine (or other μ-opioid receptor agonist) for break-through (episodic) pain and to switch either way between buprenorphine and morphine (or other μ-opioid receptor agonist) without loss of analgesia.
    • Despite concerns that antagonism could occur, this is likely only with a very large dose; even with buprenorphine 32mg SL, only 84% of μ-opioid receptors are occupied.
    • A recent study in volunteers suggests that buprenorphine may have an antihyperalgesic effect as well as an analgesic effect.
    • Animal studies and case reports also suggest that buprenorphine may be of particular benefit in neuropathic pain. The implications for the clinical management of neuropathic pain, if any, need to be determined by controlled studies.



BMT Update: Bortezomib in a conditioning regimen for auto transplant in multiple myeloma

Bortezomib is being used in a conditioning regimen for auto transplant in multiple myeloma.  It is combined with high dose melphalan which is given as an inpatient (U57).  This is based on the French study published in Blood. 7 Jan 2010.  Volume 115:1.  32-37.

Bortezomib is given day -5, -2, which may be given as an out patient (TBCC),  followed the remainder of the protocol given on U57 as an inpatient (melphalan day -1 and velcade day 1 and 4).

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About Onco-PRN

Welcome and thanks for visiting Onco-P.R.N. - The oncology website with a focus on all things oncology pharmacy/pain/palliative care-related. It is intended to be an information resource for those pharmacist and relevant health care professionals involved in whatever fashion with cancer and palliative care. Stay tuned for the latest and greatest links and information with respect to: oncology medications, continuing education, pharmaceutical care initiatives, pain and symptom control, supportive care topics, and whatever else that might fit into the theme.

*Note: This website is not affiliated with Alberta Health Services (AHS) or CAPhO and the opinions expressed herewithin are that of the author(s).

Pharmacy History

"The earliest known compilation of medicinal substances was ARIANA the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.
Many Sumerian (late 6th millennium BC - early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine.[3]

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article."

From Wikipedia:

Journal of Palliative Medicine - Table of Contents

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