Oxycodone Overdose in the Pediatric Population: Case Files of the University of Massachusetts Medical Toxicology Fellowship

Boyle, Katherine L.; Rosenbaum, Christopher D.

doi:10.1007/s13181-014-0394-3

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…In rare instances, a judicious use of narcotics such as oxycodone could be used with minimal dose prescription and clear instruction to parents, as oxycodone overdose, abuse, and misuse is of very high concern in the pediatric population. [13][14][15][16] The current study supports the primary care management of simple clavicle fractures. Furthermore, Koelink et al 17 demonstrated the same for distal radius buckle fractures.…”

Section: Pain Managementsupporting

confidence: 69%

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Management of Simple Clavicle Fractures by Primary Care Physicians

Stepanyan

Gendelberg

Hennrikus

2016

Clin Pediatr (Phila)

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The clavicle is the most commonly fractured bone. Children with simple fractures are often referred to orthopedic surgeons by primary care physician to ensure adequate care. The objective of this study was to show that simple clavicle fractures have excellent outcomes and are within the scope of primary care physician's practice. We performed a retrospective chart review of 16 adolescents with simple clavicle fractures treated with a sling. Primary outcomes were bony union, pain, and function. The patients with simple clavicle fractures had excellent outcomes with no complications or complaints of pain or restriction of their activities of daily living. The outcomes are similar whether treated by an orthopedic surgeon or a primary care physician. The cost to society and the patient is less when the primary care physician manages the fracture. Therefore, primary care physicians should manage simple clavicle fractures.

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Section: Pain Managementsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Management of Simple Clavicle Fractures by Primary Care Physicians

Stepanyan

Gendelberg

Hennrikus

2016

Clin Pediatr (Phila)

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“…If an individual is a CYP2D6 PM, there is an increased likelihood of an insufficient analgesic effect [97]. Conversely, several importantly case reports have identified severe respiratory depression in UM children following tonsillectomies [97][98][99]. Mothers who are CYP2D6 UMs also appear to have increased morphine present in their breast milk, and this has been associated with severe adverse events in breastfed infants [100].…”

Section: Codeinementioning

confidence: 99%

A Review of the Important Role of CYP2D6 in Pharmacogenomics

Taylor

Crosby²,

Yip

et al. 2020

Genes

171

101

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Cytochrome P450 2D6 (CYP2D6) is a critical pharmacogene involved in the metabolism of ~20% of commonly used drugs across a broad spectrum of medical disciplines including psychiatry, pain management, oncology and cardiology. Nevertheless, CYP2D6 is highly polymorphic with single-nucleotide polymorphisms, small insertions/deletions and larger structural variants including multiplications, deletions, tandem arrangements, and hybridisations with non-functional CYP2D7 pseudogenes. The frequency of these variants differs across populations, and they significantly influence the drug-metabolising enzymatic function of CYP2D6. Importantly, altered CYP2D6 function has been associated with both adverse drug reactions and reduced drug efficacy, and there is growing recognition of the clinical and economic burdens associated with suboptimal drug utilisation. To date, pharmacogenomic clinical guidelines for at least 48 CYP2D6-substrate drugs have been developed by prominent pharmacogenomics societies, which contain therapeutic recommendations based on CYP2D6-predicted categories of metaboliser phenotype. Novel algorithms to interpret CYP2D6 function from sequencing data that consider structural variants, and machine learning approaches to characterise the functional impact of novel variants, are being developed. However, CYP2D6 genotyping is yet to be implemented broadly into clinical practice, and so further effort and initiatives are required to overcome the implementation challenges and deliver the potential benefits to the bedside.

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“…CYP2D6 activity also correlated with oxycodone experimental pain assessment, with UM experiencing increased pharmacodynamic effects (61). Oxycodone overdose by wrong dosing has been reported before (62). Interestingly, CYP2D6*4 allele (PM) implicated in the death of four fatalities from oxycodone, by a retrospective analysis of 15 cases from the Milwaukee County Medical Examiner's Office using pharmacogenomics for postmortem forensic toxicology(63).…”

Section: Introductionmentioning

confidence: 96%

Codeine and opioid metabolism

Chidambaran

Sadhasivam

Mahmoud

2017

Current Opinion in Anaesthesiology

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Purpose of review Use of perioperative opioids for surgical pain management of children presents clinical challenges because of concerns of serious adverse effects including life-threatening respiratory depression. This is especially true for children with history of obstructive sleep apnea. This review will explore current knowledge of clinically relevant factors and genetic polymorphisms that affect opioid metabolism and postoperative outcomes in children. Recent findings Within the past several years, an increasing number of case reports have illustrated clinically important respiratory depression, anoxic brain injuries and even death among children receiving appropriate weight-based dosages of codeine and other opioids for analgesia at home setting particularly following tonsillectomy. Several national and international organizations have issued advisories on use of codeine in pediatrics, based on CYP2D6 pharmacogenetics. We have discussed the pros and cons of alternatives to codeine for pain management. Summary Although routine preoperative genotyping to identify children at risk and personalized opioid use for pediatric perioperative pain management is still a distant reality, current known implications of CYP2D6 pharmacogenetics on codeine use shows that pharmacogenetics has the potential to guide anesthesia providers on perioperative opioid selection and dosing to maximize efficacy and safety.

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Oxycodone Overdose in the Pediatric Population: Case Files of the University of Massachusetts Medical Toxicology Fellowship

Cited by 7 publications

References 36 publications

Management of Simple Clavicle Fractures by Primary Care Physicians

Management of Simple Clavicle Fractures by Primary Care Physicians

A Review of the Important Role of CYP2D6 in Pharmacogenomics

Codeine and opioid metabolism

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