Targeted Drug Delivery: Strategy for Individualized Precision Medicine

Outline

1. Identify the role of targeted drug delivery in specific indications.
2. Application of principles of precision medicine to targeted drug delivery therapy.
3. Understand the role of catheter tip placement in improving outcomes based on CSF flow dynamics and drug kinetics.

Accreditation & Designation 

Release date: This activity was released 8/19/2022.

Termination date: The content of this activity remains eligible for CME Credit until 8/18/2025, unless reviewed or amended prior to this date.

Claiming Credit: Watch the entire presentation and complete the Improvement Plan/Evaluation.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

California Required CME on Pain Management and the Appropriate Treatment of the Terminally Ill
AB487 requires physicians licensed in California to complete a one-time CME activity for 12 hours of credits that addresses both pain management and the appropriate care and treatment of the terminally ill. This activity contributes to achievement of requirements with AB487.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

[Presenter] Hemant Kalia discloses the following financial relationships within the past 24 months: Consulting: Abbott, Omnia, RR Intellect Healthcare Solutions

No other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships have been mitigated. Materials were reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. In some cases, content may have been modified as part of the review and mitigation process. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).

Additional Reading

• Schultz, D. M., Abd-Elsayed, A., Calodney, A., Stromberg, K., Weaver, T., & Spencer, R. J. (2021). Targeted drug delivery for chronic nonmalignant pain: longitudinal data from the product surveillance registry. Neuromodulation: Technology at the Neural Interface, 24(7), 1167-1175.
• Knight KH, Brand FM, Mchaourab AS, Veneziano G. Implantable intrathecal pumps for chronic pain: highlights and updates. Croat Med J. 2007 Feb;48(1):22-34. PMID: 17309136; PMCID: PMC2080496.
• Kim DD, Patel A, Sibai N. Conversion of Intrathecal Opioids to Fentanyl in Chronic Pain Patients With Implantable Pain Pumps: A Retrospective Study. Neuromodulation. 2019 Oct;22(7):823-827. doi: 10.1111/ner.12936. Epub 2019 Mar 6. PMID: 30840355.
• Gorlin AW, Rosenfeld DM, Maloney J, Wie CS, McGarvey J, Trentman TL. Survey of pain specialists regarding conversion of high-dose intravenous to neuraxial opioids. J Pain Res. 2016 Sep 21;9:693-700. doi: 10.2147/JPR.S113216. PMID: 27703394; PMCID: PMC5036565.
• Miljanich, G., Rauck, R., & Saulino, M. (2013). Spinal mechanisms of pain and analgesia. Pain Practice, 13(2), 114-130.
• Deer, T. R., Pope, J. E., Hayek, S. M., Bux, A., Buchser, E., Eldabe, S., ... & Mekhail, N. (2017). The Polyanalgesic Consensus Conference (PACC): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation: Technology at the Neural Interface, 20(2), 96-132.
• Ummenhofer, W. C., Arends, R. H., Shen, D. D., & Bernards, C. M. (2000). Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. The Journal of the American Society of Anesthesiologists, 92(3), 739-753.
• Bernards, C. M. (2006). Cerebrospinal fluid and spinal cord distribution of baclofen and bupivacaine during slow intrathecal infusion in pigs. The Journal of the American Society of Anesthesiologists, 105(1), 169-178.
• Flack, S. H., & Bernards, C. M. (2010). Cerebrospinal fluid and spinal cord distribution of hyperbaric bupivacaine and baclofen during slow intrathecal infusion in pigs. The Journal of the American Society of Anesthesiologists, 112(1), 165-173.