Analysis of Intensive Care Unit Admission and Sequelae in Patients Intravenously Abusing Extended-Release Oral Oxymorphone

Wilson, Matthew W.; Bonnecaze, Alex K; Dharod, Ajay; Miller, Peter

doi:10.14423/smj.0000000000000624

Cited by 7 publications

(5 citation statements)

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“…This is particularly striking because our analysis was based on the PK profiles of young, healthy women and not persons chronically ill from injection drug use. While acute kidney injury has been noted as a sequela of injection drug use (Wilson et al, 2017), normal renal function was assumed in this analysis. Other population models for TFV and FTC pharmacokinetics include a covariate effect of creatinine clearance on parent drug clearance.…”

Section: Discussionmentioning

confidence: 99%

A Pharmacokinetic/Pharmacodynamic Model to Predict Effective HIV Prophylaxis Dosing Strategies for People Who Inject Drugs

Garrett

Chen

Maas

et al. 2018

J Pharmacol Exp Ther

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The goal of this work was to evaluate dosing strategies for tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), and emtricitabine (FTC) for pre-exposure prophylaxis (PrEP) with injection drug use with a pharmacokinetic/pharmacodynamics analysis of concentration data generated from two single-dose clinical studies conducted in healthy women. Population pharmacokinetic models were developed using measured intracellular metabolite, endogenous nucleotide competitors, and extracellular parent drug concentrations. Intracellular metabolite concentrations were normalized to endogenous competitors and compared with an EC target for PrEP efficacy. Monte Carlo simulations were used to select effective dose strategies of single agents (TAF, TDF, and FTC) and combinations (TDF + FTC and TAF + FTC). Daily, intermittent, and event-driven dosing regimens at varying dosage amounts were explored. When combined, TDF + FTC and TAF + FTC both provided quick (0.5 hours) and durable (up to 84 and 108 hours, respectively) protection of ≥99% after a single dose. When dosed twice per week, protection remained at 100%. Single-agent regimens provided lower estimates of protection than either combination tested. Here, the application of pharmacokinetic modeling to in vitro target concentrations demonstrates the added utility of including FTC in a successful PrEP regimen. While no TAF-based PrEP data are currently available for comparison, this analysis suggests TAF + FTC could completely protect against percutaneous exposure with as little as two doses per week.

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Section: Discussionmentioning

confidence: 99%

A Pharmacokinetic/Pharmacodynamic Model to Predict Effective HIV Prophylaxis Dosing Strategies for People Who Inject Drugs

Garrett

Chen

Maas

et al. 2018

J Pharmacol Exp Ther

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“…Patients undergone several paraclinical explorations (median=5, (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)) to determine different septic localizations of ITE: pulmonary parenchyma (n = 12), lung septic emboli (n = 7), pleural effusions (n = 8) and renal abscess (n = 2).…”

Section: Resultsmentioning

confidence: 99%

“…In 2016, mortality reported in a small Indian cohort of 11 ICU patients IDUs having right-sided endocarditis was of 9% [8]. In 2017, Wilson et al [9] retrospectively reviewed 53 IDUs admitted to ICU from whom 30 (56.6%) had acute infective bacterial endocarditis: these patients demonstrated a high need to critical care resources, especially mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

The Infectious Tricuspid Endocarditis in ICU: Clinical Features, Management and Outcome

Jamoussi¹,

Merhebene²,

Ismail³

et al. 2017

JPP

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Objectives: Infectious tricuspid endocarditis is known to simply require antibiotherapy and to have good prognosis in most cases. Few studies focused on severe episodes managed in ICU. We aimed to describe clinical and microbiological features, and final outcome of infectious tricuspid endocarditis managed in ICU. Methods: From all patients hospitalized in intensive care unit with infectious tricuspid endocarditis were enrolled. Key findings: We collected 15 episodes of infectious tricuspid endocarditis. Median age was of 39 years. Risk factors were: intravenous drug users (n = 10), pace maker (n = 1), vascular device (n = 2), none (n = 2). Median SAPS II, APACHE II and SOFA on admission were 21, 10 and 2 respectively. Organ failures on admission were: acute respiratory failure (n = 10), sepsis (n = 7), coma (n = 1) and acute kidney injury (n = 8). The most frequent causative pathogen was Staphylococcus Aureus. Antibiotherapy failure happened in 10 patients from whom 8 underwent cardiac surgery (53.3%). Most frequent complications were acute kidney injury (n = 14) and withdrawal syndrom. Infectious tricuspid endocarditis relapse on bioprosthesis occurred within 2 intravenous drug users after hospital discharge. Overall in-hospital mortality was 40%. Conclusions: Infectious tricuspid endocarditis in ICU is fitted with poor prognosis and high need to cardiac surgery. Special care should be provided to intravenous drug users to prevent relapse.Corresponding author: Jamoussi Amira, M.D., research fields: respiratory critical care. predictors and long-term imperative needs. That's why reporting experiences worldwide is essential to build consensual short and long-term management for severe right-sided infectious endocarditis.This study focused on ITE (infectious tricuspid endocarditis) managed in ICU (intensive care unit) and aimed to describe the clinical and microbiological features, risk factors, medical and surgical treatments, and final outcome. Methods ICU PresentationOur unit is a 22 bed medical ICU with a respiratory valence. It belongs to a teaching university hospital of pneumology (301 beds): Abderrahmen Mami hospital of Ariana, Tunisia. The mean number of ICU admissions is about 545 per year.

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“…Case reports exist supporting the use of ECMO for lung injury caused by opioid abuse [7]. However, hemoptysis related to opioids is known to exist in the context of Thrombotic Microangiopathy (TMA) due to rapid hemolysis [8,9]. The presenting picture of this patient posed a challenging scenario for physicians prior to obtaining a kidney biopsy.…”

Section: Discussionmentioning

confidence: 98%

Extracorporeal Life Support for Massive Hemoptysis and Acute Lung Injury Due to ANCA Negative Vasculitis

2021

JACCR

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Massive hemoptysis is life-threatening and extracorporeal membrane oxygenation (ECMO) may be indicated as rescue therapy due to acute lung injury in this setting. We report a case of a patient who presented with massive hemoptysis and acute lung injury after reported inhaled ground oxymorphone abuse. Although initially thought to have been due to inhaled oxymorphone, we determined that the patient had ANCA-negative vasculitis that led to both hemoptysis and hematuria. The role of inhaled oxymorphone in combination with the vasculitis is unknown. ECMO was initiated to support the patient and, although his course was complicated, he did recover. Keywords: ECMO; Vasculitis; Acute Respiratory Distress (ARDS).

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Analysis of Intensive Care Unit Admission and Sequelae in Patients Intravenously Abusing Extended-Release Oral Oxymorphone

Cited by 7 publications

References 0 publications

A Pharmacokinetic/Pharmacodynamic Model to Predict Effective HIV Prophylaxis Dosing Strategies for People Who Inject Drugs

A Pharmacokinetic/Pharmacodynamic Model to Predict Effective HIV Prophylaxis Dosing Strategies for People Who Inject Drugs

The Infectious Tricuspid Endocarditis in ICU: Clinical Features, Management and Outcome

Extracorporeal Life Support for Massive Hemoptysis and Acute Lung Injury Due to ANCA Negative Vasculitis

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