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1.
J Pharm Pract ; : 897190019853992, 2019 Jun 27.
Artículo en Inglés | MEDLINE | ID: mdl-31248317

RESUMEN

OBJECTIVE: We describe a case of morphine toxicity presumably caused by accumulation of its active metabolite morphine-6-glucuronide (M6G) secondary to reduced clearance by peritoneal dialysis. METHODS: We present the relevant history and laboratory data and review pertinent literature regarding the use of opioids in renal failure. RESULTS: A 76-year-old African-American female received one dose of morphine sulfate and developed signs and symptoms of morphine toxicity for 2 days, even after multiple peritoneal dialysis sessions. CONCLUSION: Because of reduced renal clearance of morphine and its metabolites in patients requiring peritoneal dialysis, morphine should be avoided as an analgesic option in this population due to increased risk of morphine toxicity.

2.
J Pharm Pract ; 30(1): 31-36, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26038244

RESUMEN

This cross-sectional study enrolled 180 patients at a private family practice in Virginia. Total serum vitamin D concentrations were obtained weekly from January 30, 2013, through March 30, 2013, in consecutive patients regularly scheduled for laboratory work at the practice. Patients were categorized into 2 groups and analyzed for variant alleles in vitamin D receptor ( VDR; rs2228570), cytochrome P450 2R1 ( CYP2R1; rs10741657), 7-dehydrocholesterol reductase ( DHCR7; rs12785878), and group-specific component ( GC; rs2282679) to determine whether variants of those alleles influenced total serum 25(OH)D concentrations. One-hundred and eighty patients were enrolled, with 40 (22%) being sufficient, 25-hydroxy vitamin D level 25(OH)D ≥ 30 ng/mL, and 140 (78%) being insufficient, 25(OH)D < 30 ng/mL. Of the 4 genes, 2 genes, CYP2R1 (rs10741657) and GC (rs2282679), demonstrated a significant association related to vitamin D status. Subjects with 1 or more variant alleles at rs10741657 were almost 3.7 (odds ratio [OR] 3.67; 95% confidence interval [CI]: 1.35-9.99) times more likely be insufficient in vitamin D and subjects with 1 or more variant alleles at rs2282679 were about half (OR 0.42; 95% CI: 0.18-0.93) as likely to be insufficient in vitamin D. Allelic variations in CYP2R1 (rs10741657) and GC (rs2282679) affect vitamin D levels, but variant alleles on VDR (rs2228570) and DHCR7 (rs12785878) were not correlated with vitamin D deficiency, 25(OH)D < 30 ng/mL.


Asunto(s)
Colestanotriol 26-Monooxigenasa/genética , Familia 2 del Citocromo P450/genética , Oxidorreductasas actuantes sobre Donantes de Grupo CH-CH/genética , Receptores de Calcitriol/genética , Deficiencia de Vitamina D/genética , Proteína de Unión a Vitamina D/genética , Anciano , Alelos , Estudios Transversales , Femenino , Predisposición Genética a la Enfermedad/genética , Humanos , Masculino , Persona de Mediana Edad , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre
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