INTRAVENOUS ANAESTHESIA Dr
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Kava (Piper Methysticum) and Its Methysticin Constituents Protect Brain Tissue Against Ischemic Damage in Rodents
5 Refs: Arletti R et al, Stimulating property of Turnera diffusa and Pfaffia paniculata extracts on the sexual-behavior of male rats. Psychopharmacology 143(1), 15-19, 1999. Berger F, Handbuch der drogenkunde . Vol 2, Maudrich, Wien, 1950. Martinez M, Les plantas medicinales de Mexico . Cuarta Edicion Botas Mexico , p119, 1959. Tyler VE et al, Pharmacognosy , 9 th edition, Lea & Febiger, Philadelphia, 1988. KAVA ( Piper methysticum ) - A REVIEW The Kava plant (Piper methysticum) is a robust, well-branching and erect perennial shrub belonging to the pepper family (Piperaceae). The botanical origin remains unknown, although it is likely that early Polynesian explorers brought the plant with them from island to island. Numerous varieties of Kava exist, and today it is widely cultivated in several Pacific Island countries both for local use as well as the rapidly growing demand for pharmaceutical preparations. The dried rhizomes (roots) are normally used. The first description to the western world of the ceremonial use of an intoxicating beverage prepared from Kava was made by Captain James Cook following his Pacific voyage in 1768. The drink, prepared as an infusion in an elaborate manner after first chewing the root, is consumed on formal occasions or meetings of village elders and chiefs, as well as in reconciling with enemies and on a more social basis. It remains an important social custom in many Pacific Island countries today. Most of the islands of the Pacific possessed Kava prior to European contact, particularly those encompassed by Polynesia, Melanesia and Micronesia. After drinking the Kava beverage a pleasantly relaxed and sociable state develops, after which a deep and restful sleep occurs. -
Journal of Pharmacology and Experimental Therapeutics
Journal of Pharmacology and Experimental Therapeutics Molecular Determinants of Ligand Selectivity for the Human Multidrug And Toxin Extrusion Proteins, MATE1 and MATE-2K Bethzaida Astorga, Sean Ekins, Mark Morales and Stephen H Wright Department of Physiology, University of Arizona, Tucson, AZ 85724, USA (B.A., M.M., and S.H.W.) Collaborations in Chemistry, 5616 Hilltop Needmore Road, Fuquay-Varina NC 27526, USA (S.E.) Supplemental Table 1. Compounds selected by the common features pharmacophore after searching a database of 2690 FDA approved compounds (www.collaborativedrug.com). FitValue Common Name Indication 3.93897 PYRIMETHAMINE Antimalarial 3.3167 naloxone Antidote Naloxone Hydrochloride 3.27622 DEXMEDETOMIDINE Anxiolytic 3.2407 Chlordantoin Antifungal 3.1776 NALORPHINE Antidote Nalorphine Hydrochloride 3.15108 Perfosfamide Antineoplastic 3.11759 Cinchonidine Sulfate Antimalarial Cinchonidine 3.10352 Cinchonine Sulfate Antimalarial Cinchonine 3.07469 METHOHEXITAL Anesthetic 3.06799 PROGUANIL Antimalarial PROGUANIL HYDROCHLORIDE 100MG 3.05018 TOPIRAMATE Anticonvulsant 3.04366 MIDODRINE Antihypotensive Midodrine Hydrochloride 2.98558 Chlorbetamide Antiamebic 2.98463 TRIMETHOPRIM Antibiotic Antibacterial 2.98457 ZILEUTON Antiinflammatory 2.94205 AMINOMETRADINE Diuretic 2.89284 SCOPOLAMINE Antispasmodic ScopolamineHydrobromide 2.88791 ARTICAINE Anesthetic 2.84534 RITODRINE Tocolytic 2.82357 MITOBRONITOL Antineoplastic Mitolactol 2.81033 LORAZEPAM Anxiolytic 2.74943 ETHOHEXADIOL Insecticide 2.64902 METHOXAMINE Antihypotensive Methoxamine -
Alternative Treatments for Depression and Anxiety
2019 PCB Conference: Strickland Benzodiazepines (BZDs), Herbal and Alternative Treatments for Anxiety & Depression BZD Learning Objectives • List at least three uses for benzodiazepines • Discuss at least two risk factors associated with benzodiazepine prescriptions Craig Strickland, PhD, Owner Biobehavioral Education and Consultation https://sites.google.com/site/bioedcon 1 2 BZD Pharmacokinetics Clinical Uses of BZDs Generic Name Trade Name Rapidity ½ Life Dose (mg) • Treat a variety of anxiety disorders alprazolam Xanax Intermediate Short 0.75-4 • Hypnotics • Muscle relaxants chlordiaze- Librium Intermediate Long 15-100 poxide • To produce anterograde amnesia clonazepam Klonopin Intermediate Long 0.5-4 • Alcohol & other CNS depressant withdrawal • Anti-convulsant therapy diazepam Valium Rapid Long 4-40 triazolam Halcion Intermediate Very short 0.125-0.5 temazepam Restoril Short Short 7.5-30 3 4 1 2019 PCB Conference: Strickland Issues with BZDs Herbal Medication and Alternative Therapies Used in the Treatment of Depression and Anxiety • Addictive potential • Confusion between “anti-anxiety” effects and the “warm-fuzzy) • Large dose ranges • Comparison of BZDs with medications like Buspar, etc. • They work, they work well and they work quickly 5 6 Alternative Tx. Learning Objectives Background Information on herbals: Natural does not necessarily mean “safe” • List several amino acid treatments for depression • Side-effects and adverse reactions • List at least three of the most common herbal – Herbal medications are “drugs” although -
Phenobarbital Brand Name: Phenobarb
Generic Name: Phenobarbital Brand Name: Phenobarb What Is It Used For? Decreasing seizure activity in various types of seizures. Especially useful for controlling seizures in neonates and infants Given intravenously in the emergency department for status epilepticus. How Long Does The Oral Medicine Take to Work? 10-30 days What Are The Important Safety Concerns? When first starting the medicine, your child may be slightly drowsy and/or dizzy. Only adjust the dosage as recommended by your health care provider. They will usually increase this medication slowly to avoid side effects. Never increase the dosage more than once per week unless directed otherwise. Once you have started with one brand of the medication stay with it. Avoid switching between different brands. Check with your pharmacist before taking herbal medications and/or over-the- counter medications. They may have adverse effects if taken with anti-seizure medications. Do not stop taking this medication suddenly because this could result in seizures. It is important to keep a record of your child’s seizures and side effects to determine how well they are responding to the medication. Does My Child Need Bloodwork With This Medication? Routine blood work may be done to help determine the best dosage for your child, and also if they have side effects to the medication. If your child is required to have blood work it must be done BEFORE they get the medication. This is called a trough level. This level usually falls between 65 and 170. A blood test may be done before starting this medication to check your child’s liver function and blood counts. -
PENTOBARBITAL SODIUM- Pentobarbital Sodium Injection Akorn, Inc
PENTOBARBITAL SODIUM- pentobarbital sodium injection Akorn, Inc. ---------- Nembutal® Sodium Solution CII (pentobarbital sodium injection, USP) + novaplus TM Rx only Vials DO NOT USE IF MATERIAL HAS PRECIPITATED DESCRIPTION The barbiturates are nonselective central nervous system depressants which are primarily used as sedative hypnotics and also anticonvulsants in subhypnotic doses. The barbiturates and their sodium salts are subject to control under the Federal Controlled Substances Act (See “Drug Abuse and Dependence” section). The sodium salts of amobarbital, pentobarbital, phenobarbital, and secobarbital are available as sterile parenteral solutions. Barbiturates are substituted pyrimidine derivatives in which the basic structure common to these drugs is barbituric acid, a substance which has no central nervous system (CNS) activity. CNS activity is obtained by substituting alkyl, alkenyl, or aryl groups on the pyrimidine ring. NEMBUTAL Sodium Solution (pentobarbital sodium injection) is a sterile solution for intravenous or intramuscular injection. Each mL contains pentobarbital sodium 50 mg, in a vehicle of propylene glycol, 40%, alcohol, 10% and water for injection, to volume. The pH is adjusted to approximately 9.5 with hydrochloric acid and/or sodium hydroxide. NEMBUTAL Sodium is a short-acting barbiturate, chemically designated as sodium 5-ethyl-5-(1- methylbutyl) barbiturate. The structural formula for pentobarbital sodium is: The sodium salt occurs as a white, slightly bitter powder which is freely soluble in water and alcohol but practically insoluble in benzene and ether. CLINICAL PHARMACOLOGY Barbiturates are capable of producing all levels of CNS mood alteration from excitation to mild sedation, to hypnosis, and deep coma. Overdosage can produce death. In high enough therapeutic doses, barbiturates induce anesthesia. -
Benzodiazepines: Uses and Risks Charlie Reznikoff, MD Hennepin Healthcare
Benzodiazepines: Uses and Risks Charlie Reznikoff, MD Hennepin healthcare 4/22/2020 Overview benzodiazepines • Examples of benzos and benzo like drugs • Indications for benzos • Pharmacology of benzos • Side effects and contraindications • Benzo withdrawal • Benzo tapers 12/06/2018 Sedative/Hypnotics • Benzodiazepines • Alcohol • Z-drugs (Benzo-like sleeping aids) • Barbiturates • GHB • Propofol • Some inhalants • Gabapentin? Pregabalin? 12/06/2018 Examples of benzodiazepines • Midazolam (Versed) • Triazolam (Halcion) • Alprazolam (Xanax) • Lorazepam (Ativan) • Temazepam (Restoril) • Oxazepam (Serax) • Clonazepam (Klonopin) • Diazepam (Valium) • Chlordiazepoxide (Librium) 4/22/2020 Sedatives: gaba stimulating drugs have incomplete “cross tolerance” 12/06/2018 Effects from sedative (Benzo) use • Euphoria/bliss • Suppresses seizures • Amnesia • Muscle relaxation • Clumsiness, visio-spatial impairment • Sleep inducing • Respiratory suppression • Anxiolysis/disinhibition 12/06/2018 Tolerance to benzo effects? • Effects quickly diminish with repeated use (weeks) • Euphoria/bliss • Suppresses seizures • Effects incompletely diminish with repeated use • Amnesia • Muscle relaxation • Clumsiness, visio-spatial impairment • Seep inducing • Durable effects with repeated use • Respiratory suppression • Anxiolysis/disinhibition 12/06/2018 If you understand this pharmacology you can figure out the rest... • Potency • 1 mg diazepam <<< 1 mg alprazolam • Duration of action • Half life differences • Onset of action • Euphoria, clinical utility in acute -
AHFS Pharmacologic-Therapeutic Classification System
AHFS Pharmacologic-Therapeutic Classification System Abacavir 48:24 - Mucolytic Agents - 382638 8:18.08.20 - HIV Nucleoside and Nucleotide Reverse Acitretin 84:92 - Skin and Mucous Membrane Agents, Abaloparatide 68:24.08 - Parathyroid Agents - 317036 Aclidinium Abatacept 12:08.08 - Antimuscarinics/Antispasmodics - 313022 92:36 - Disease-modifying Antirheumatic Drugs - Acrivastine 92:20 - Immunomodulatory Agents - 306003 4:08 - Second Generation Antihistamines - 394040 Abciximab 48:04.08 - Second Generation Antihistamines - 394040 20:12.18 - Platelet-aggregation Inhibitors - 395014 Acyclovir Abemaciclib 8:18.32 - Nucleosides and Nucleotides - 381045 10:00 - Antineoplastic Agents - 317058 84:04.06 - Antivirals - 381036 Abiraterone Adalimumab; -adaz 10:00 - Antineoplastic Agents - 311027 92:36 - Disease-modifying Antirheumatic Drugs - AbobotulinumtoxinA 56:92 - GI Drugs, Miscellaneous - 302046 92:20 - Immunomodulatory Agents - 302046 92:92 - Other Miscellaneous Therapeutic Agents - 12:20.92 - Skeletal Muscle Relaxants, Miscellaneous - Adapalene 84:92 - Skin and Mucous Membrane Agents, Acalabrutinib 10:00 - Antineoplastic Agents - 317059 Adefovir Acamprosate 8:18.32 - Nucleosides and Nucleotides - 302036 28:92 - Central Nervous System Agents, Adenosine 24:04.04.24 - Class IV Antiarrhythmics - 304010 Acarbose Adenovirus Vaccine Live Oral 68:20.02 - alpha-Glucosidase Inhibitors - 396015 80:12 - Vaccines - 315016 Acebutolol Ado-Trastuzumab 24:24 - beta-Adrenergic Blocking Agents - 387003 10:00 - Antineoplastic Agents - 313041 12:16.08.08 - Selective -
CDHO Factsheet Epilepsy
Disease/Medical Condition EPILEPSY Date of Publication: August 7, 2014 (also known as “seizure disorder”) Is the initiation of non-invasive dental hygiene procedures* contra-indicated? No Is medical consult advised? ...................................... No (assuming patient/client is already under medical care for epilepsy, which is well controlled) Is the initiation of invasive dental hygiene procedures contra-indicated?** No Is medical consult advised? ....................................... Possibly (e.g., if there is medication non-compliance) Is medical clearance required? .................................. Possibly (e.g., if there is significant risk of seizure; patient/ client should be seizure-free for several months to be considered controlled) Is antibiotic prophylaxis required? .............................. No Is postponing treatment advised? ............................... No (assuming patient/client is already under medical care for epilepsy, which is well controlled and for which there are no anticipated exacerbating factors in the office setting) Oral management implications Important considerations in the management of epileptic patients/clients are prevention of seizures in the dental chair and preparation for managing seizures if they occur. When a patient/client responds positively to questions about seizures/ epilepsy during health history taking, further information should be obtained. Based on the patient/client’s responses, the dental hygienist may choose to postpone treatment to avoid triggering a seizure in the dental chair. It is valuable for the dental hygienist to know what factors have the potential to exacerbate epileptic seizures in a particular patient/client in order that trigger stimuli can be avoided. The dental hygienist can reduce stress and anxiety by explaining procedures before starting. Bright light should be kept out of the patient/client’s eyes, and dark glasses may assist with this. -
Jebmh.Com Original Research Article
Jebmh.com Original Research Article A COMPARATIVE STUDY OF SMALL DOSE OF KETAMINE, MIDAZOLAM AND PROPOFOL AS COINDUCTION AGENT TO PROPOFOL Abhimanyu Kalita1, Abu Lais Mustaq Ahmed2 1Senior Resident, Department of Anaesthesiology, Assam Medical College, Dibrugarh. 2Associate Professor, Department of Anaesthesiology, Assam Medical College, Dibrugarh. ABSTRACT BACKGROUND The technique of “coinduction”, i.e. use of a small dose of sedative agent or another anaesthetic agent reduces the dose requirement as well as adverse effects of the main inducing agent. Ketamine, midazolam and propofol have been used as coinduction agents with propofol. MATERIALS AND METHODS This prospective, randomised clinical study compared to three methods of coinduction. One group received ketamine, one group received midazolam and one group received propofol as coinducing agent with propofol. RESULTS The study showed that the group receiving ketamine as coinduction agent required least amount of propofol for induction and was also associated with lesser side effects. CONCLUSION Use of ketamine as coinduction agent leads to maximum reduction of induction dose of propofol and also lesser side effects as compared to propofol and midazolam. KEYWORDS Coinduction, Propofol, Midazolam, Ketamine. HOW TO CITE THIS ARTICLE: Kalita A, Ahmed ALM. A comparative study of small dose of ketamine, midazolam and propofol as coinduction agent to propofol. J. Evid. Based Med. Healthc. 2017; 4(64), 3820-3825. DOI: 10.18410/jebmh/2017/763 BACKGROUND But, the major disadvantage of propofol induction are Propofol is the most frequently used IV anaesthetic agent impaired cardiovascular and respiratory function, which may used today with a desirable anaesthetic profile. It provides put the patients at a higher risk of bradycardia, hypotension faster onset of action, antiemesis, rapid recovery with and apnoea. -
Deliberate Self-Poisoning with a Lethal Dose of Pentobarbital: Survival with Supportive Care
Deliberate self-poisoning with a lethal dose of pentobarbital: Survival with supportive care. (1) (1,2) Santosh Gone , Andis Graudins (1) Clinical Toxicology Service, Program of Emergency Medicine, Monash Health (2) Monash Emergency Research Collaboration, Clinical Sciences at Monash Health, Monash University Abstract 84 INTRODUCTION CASE REPORT (continued) DISCUSSION Pentobarbital (Nembutal) is short acting In the ED: Pentobarbital has been a banned substance for barbiturate sedative-hypnotic, currently widely GCS: 3/15, fixed dilated pupils, apnoeic and human use in Australia since 1998. However, it can used in veterinary practice for anesthesia and ventilated. be procured overseas or bought on the internet. euthanasia. Pulse: 116 bpm sinus tachycardia BP: 115/60 on epinephrine infusion. Pentobarbital is recommended as an effective It is also commonly recommended as a VBG: pH 7.03 pCO2 77 mmHg Bicarb 19 mmol/L agent for use in euthanasia due to its apparently euthanasia drug for assisted suicide and it is Lactate 8.8 mmol/L peaceful transition to death. unlikely that any resuscitative measures will be Activated charcoal (50g) given via an NG tube. attempted in such cases. Course in the Intensive Care Department: In a case series of 150 assisted suicides in Day-1 post-OD: Sweden, a 100% success rate was seen with Intentional overdose results in depression of - Absent brain stem reflexes and fixed dilated pupils for ingestion of 9 grams. Cardiovascular collapse was brain stem function and rapid onset respiratory five days. seen within 15 minutes in 30% of patients. It is rare depression and apnoea. Hypotension also - Diabetes insipidus developed with urine output of to see survival after intentional ingestion for develops, followed by cardiovascular collapse 300ml/hour. -
Pentobarbital Sodium
PENTobarbital Sodium Brand names Nembutal Sodium Medication error Look-alike, sound-alike drug names. Tall man letters (not FDA approved) are recommended potential to decrease confusion between PENTobarbital and PHENobarbital.(1,2) ISMP recommends the following tall man letters (not FDA approved): PENTobarbital.(30) Contraindications Contraindications: In patients with known hypersensitivity to barbiturates or any com- and warnings ponent of the formulation.(2) If an allergic or hypersensitivity reaction or a life-threatening adverse event occurs, rapid substitution of an alternative agent may be necessary. If pentobarbital is discontinued due to development of a rash, an anticonvulsant that is structurally dissimilar should be used (i.e., nonaromatic). (See Rare Adverse Effects in the Comments section.) Also contraindicated in patients with a history of manifest or latent porphyria.(2) Warnings: Rapid administration may cause respiratory depression, apnea, laryngospasm, or vasodilation with hypotension.(2) Should be withdrawn gradually if large doses have been used for prolonged periods.(2) Paradoxical excitement may occur or important symptoms could be masked when given to patients with acute or chronic pain.(2) May be habit forming. Infusion-related Respiratory depression and arrest requiring mechanical ventilation may occur. Monitor cautions oxygen saturation. If hypotension occurs, the infusion rate should be decreased and/or the patient should be treated with IV fluids and/or vasopressors. Pentobarbital is an alkaline solution (pH = 9–10.5); therefore, extravasation may cause tissue necrosis.(2) (See Appendix E for management.) Gangrene may occur following inadvertent intra-arterial injection.(2) Dosage Medically induced coma (for persistently elevated intracranial pressure (ICP) or refractory status epilepticus): Patient should be intubated and mechanically ventilated. -
1,1,1-Trichloroethane (CASRN 71-55-6) | IRIS
Integrated Risk Information System (IRIS) U.S. Environmental Protection Agency Chemical Assessment Summary National Center for Environmental Assessment 1,1,1-Trichloroethane; CASRN 71-55-6 Human health assessment information on a chemical substance is included in the IRIS database only after a comprehensive review of toxicity data, as outlined in the IRIS assessment development process. Sections I (Health Hazard Assessments for Noncarcinogenic Effects) and II (Carcinogenicity Assessment for Lifetime Exposure) present the conclusions that were reached during the assessment development process. Supporting information and explanations of the methods used to derive the values given in IRIS are provided in the guidance documents located on the IRIS website. STATUS OF DATA FOR 1,1,1-Trichloroethane File First On-Line 03/31/1987 Category (section) Assessment Available? Last Revised Oral RfD (I.A.) Acute Oral RfD (I.A.1.) qualitative discussion 09/28/2007 Short-term Oral RfD (I.A.2.) qualitative discussion 09/28/2007 Subchronic Oral RfD (I.A.3.) yes 09/28/2007 Chronic Oral RfD (I.A.4.) yes 09/28/2007 Inhalation RfC (I.B.) Acute Inhalation RfC (I.B.1.) yes 09/28/2007 Short-term Inhalation RfC (I.B.2.) yes 09/28/2007 Subchronic Inhalation RfC (I.B.3.) yes 09/28/2007 1 Integrated Risk Information System (IRIS) U.S. Environmental Protection Agency Chemical Assessment Summary National Center for Environmental Assessment Category (section) Assessment Available? Last Revised Chronic Inhalation RfC (I.B.4.) yes 09/28/2007 Carcinogenicity Assessment (II.) yes 09/28/2007 I. Health Hazard Assessments for Noncarcinogenic Effects I.A.