The steady rise in prescription opiate mortality has led to recommendations by the CDC to sharply curtail use of opiates in treatment of chronic nonmalignant pain, limit opioid dosage to extremely low levels, and replace opioid treatment with alternatives. These recommendations ignore extensive scientific evidence of the efficacy of opioids, even in chronic pain management. They overestimate the prevalence of side effects. They vastly overestimate the prevalence of addiction in the clinical setting, likely confusing it with patient requests for dose changes motivated by persistent pain. They strongly recommend the use of alternatives to opioid management that are not supported by sufficient clinical trial evidence to justify translation to the clinic. They do not consider suffering to be sufficient motivation for treatment. They focus on total opioid mortality, rather than defining it as a quantifiable risk (approximately 1%/year) that should be considered in medical decision making, and implicitly assume that chronic pain is a minor problem that could not possibly justify the incursion of significant risk. Guidelines have failed to emphasize key principles of opioid management (e.g., individualized dose titration; treatment of depression; and utilization of control of pain, rather than an analog scale of pain magnitude, as a guide to treatment). By and large, the development of guidelines has failed to even consider the reasons for opiate deaths and how better management of chronic pain could both reduce risk of death and improve pain control. In this review, I consider means to these ends in some detail.

While pharmacological and behavioral treatments exist for smoking cessation, there are currently no best practices for helping adolescents quit smoking. This study aimed to reach consensus regarding pharmacist recommendations for adolescent smoking cessation. Using a three-round Delphi technique, pharmacists across the USA with experience working with adolescent substance use provided quantitative and qualitative feedback on recommendations. Forty pharmacists completed Round 1, 37 completed Rounds 2 and 3. In Round 1, 36 (90%) responses included the nicotine patch, gum, or lozenge. Ten recommendations were identified in Round 1: nicotine patch, nicotine gum, nicotine lozenge, bupropion SR, varenicline, quitline, smoking cessation program, counseling, behavioral approaches, and cold turkey. In Round 2, pharmacists were most likely to recommend smoking cessation programs (median=7 of 7, Interquartile range [IQR]=1) and least likely to recommend varenicline (median=3, IQR=3). In Round 3, consensus to recommend was reached on smoking cessation program (83.3% likely or very likely to recommend). Despite initially recommending nicotine replacement therapy in Round 1, by Round 3 most pharmacists were more likely to recommend behavioral treatments than pharmacological interventions for this patient population. Such preferences by pharmacists could influence the accessibility of various treatments to adolescent smokers.

Many reports have shown that Andrographolide and its derivatives possess notable anti-cancer activity. In this study, we present the molecular docking studies of some newly synthesized C-12 substituted-14-deoxy-andrographolide derivatives. This helped to evaluate the probable targets of action responsible for the observed in vitro anti-cancer activity. This work delineates the role of the interacting amino acids residues in the active site. Consequently, the structure activity relationship (SAR) helps in drug design by demonstrating the effect of the C-12 substituent on the target site drug interaction. Finally, the compliance to Lipinski's parameters demonstrates their potentialas promising leads in further anti-cancer drug development.

Background: Suicide attempts by injecting insulin glargine in non-diabetic patients are rare. Few cases have been reported.
Case report: A 49 year old man with a history of non treated disorder behavior invokes emergencies 3 hours after injecting 500 units of insulin glargine (lantus®). He was asymptomatic with normal blood glucose finger level (90mg/ml). The first episode of hypoglycemia (50mg/dl) occurred six hours after injection. He was then transferred to the intensive care unit.
He was treated with continuous intravenous infusion of 1700 g of carbohydrate with potassium supply by central venous line for severe hypokalemia at 2.8 meq/l. The last episode occurred 57 hours after the overdose insulin injection.
Conclusion: Prolonged hypoglycemia and hypokalemia are two fatal complications of poisoning with insulin glargine requiring close monitoring in the intensive care unit. This monitoring should be prolonged to avoid early interruption of dextrose infusion.

A 32 year old female patient suffering from weakness and discomfort in both flanks associated with red urine was transferred to hospital. In addition the patient showed paralysis of the right body side and seizures. Laboratory test showed a severe haemolytic anemia and thrombocytopenia with elevated values for lactate dehydrogenase. Together with the finding of fragmentocytes the diagnosis thrombotic thrombocytopenic purpura (TTP - Morbus Moschcowitz) was secured. Later low levels of ADAMTS13 and high levels of anti-ADAMTS13-antibody were determined. Treatment was started with plasma exchange with fresh frozen plasma and citrate anticoagulation (double plasma volume was exchanged in every treatment session). After initial improvement a first relapse occurred in a treatment gap. Under continued plasma exchange (17 plasma exchange treatment sessions at all) a second relapse occurred. This relapse was successful treated with rituximab. Under this combined therapy a fast and persistent clinical and biochemical improvement was achieved.