Day 2 :
Bimal Roy Krishna is currently a Professor and Director of Pharmacology at the College of Osteopathic Medicine, Touro University Nevada, USA. He has obtained his Bachelors of Science in Pharmacology and Physiology and Doctor of Philosophy from Monash University in Australia. He also teaches for the Step 1-USMLE and COMLEX reviews for Kaplan Medical throughout the United States and in UAE, Europe, Saudi Arabia, India, Mexico and Caribbean. He has been teaching online for Kaplan University for over 7 years and has contributed to numerous publications and is a Member of a number of organizations including Fellow-American College of Clinical Pharmacology. His research concern is on maternal and neonatal pharmacology specifically looking at materno-fetal transfer utilizing the perfused human placental and cultured syncytiotrophoblast model
Pain management is an integral part of therapeutics and clinical medicine. The physiology and pathology of pain whether peripheral or central involves nociception and transmission from the injured tissue-skin, muscle or viscera, afferent fibers, spinal cord sensory cells and chemical mediators play a pivotal role. Pain management is associated with a Step Up approach relating to the type of pain and underlying pathophysiology. Traditionally, Non-Steroidal Anti-Inflammatory Drugs (NSAID’s) have been the mainstay of treatment. However failure of NSAID’s to treat pain or more chronic conditions require a Step Up approach which would then introduce the opioids. Opioid analgesics address central mechanisms and are also used to treat severe pain particularly those associated with terminal illness and myocardial infarcts. The mechanisms of action of opioids are similar; however they differ in pharmacokinetic parameters. Conditions such as trigeminal neuralgia, neuropathic pain, multiple sclerosis, cerebral palsy, fibromyalgia and diabetic neuropathy are addressed differently. These conditions involve the use of Carbamazepine, Gabapentin, TCA’s and SSRIs to name a few. This presentation addresses the use of opioids and general approach for the treatment of these conditions.
St Luke’s Medical Center, Philippines
Michael O Baclig is a Scientist of Research and Biotechnology of St. Luke’s Medical Centre, Philippines. He is also an Associate Professor of the MS Molecular Medicine Program of St. Luke’s College of Medicine. He has received his MS in Microbiology and PhD in Biological Science from the University of Santo Tomas, Manila. He has received several awards including the outstanding dissertation in advanced science and technology by the Philippine Council for Industry, Energy and Emerging Technology, Research and Development-Department of Science and Technology (PCIEERD-DOST), Crisanto Almario Memorial Award and Benavides Award.
Opioids are potent analgesics and remain to be the mainstay in the management of cancer- related pain. The variation in response to opioid analgesics is partly due to genetic variability. A hospital-based cross-sectional study was conducted to investigate the association between catechol-0-methyltrasferase (COMT) and cytochrome P450 D6 (CYP2D6*10) genetic polymorphisms and opioid consumption among cancer patients. Polymorphisms in the COMT rs4680 and CYP2D6*10 rs106585 genes were identified through restriction fragment length polymorphism and nucleotide sequencing. Cancer patients with moderate pain (NRS 4-6) were prescribed with tramadol, while those having severe pain (NRS 7-9) were given morphine. None of the single nucleotide polymorphisms in the two candidate genes COMT and CYP2D6*10 showed significant associations with opioid consumption among cancer pain patients. It is likely that multiple genes rather than single gene may affect drug pharmacokinetics and pharmacodynamics and together with environmental factors may influence the clinical efficacy of opioid analgesics.