DOCSLIB.ORG

Drug Administration Routes - Summary

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Drug Administration Routes - Summary Only Use L6. DrugCourse Administration & Transport 207 by Fluid Motion 243/CENG April 19, 2018 NANO Only Use Course 207 243/CENG Part I: Drug Administration NANO Routes of Drug Administration Only Topical: local effect, substanceUse is applied directly where its action is desired. EnteralCourse: systemic effect, substance is 207given via the gastrointestinal (GI) tract. Parenteral: systemic effect, substance is given by routes other than the gastrointestinal (GI) tract. 243/CENG NANO Topical Drug Delivery Epicutaneous – directly onto the surface of the skin Only allergy testing local anesthesia… Use Eye drops antibiotics for conjunctivitis … Course Inhalational207 asthma medications acute infection in upper airway … 243/CENG Intranasal route decongestant nasal sprays … NANO Enteral Drug Delivery Any form of administration that involves any part of the gastrointestinalOnly tract Use Course 207 Oral: Rectal: Gastric feeding tube: many drugs as tablets, various drugs in many drugs, enteral capsules, drops… suppository or enema nutrition… form… 243/CENG NANO Parenteral Drug Delivery Intravenous: into a vein (many drugs, total parenteral nutrition…) Only Intramuscular: into a muscle (many vaccines, antibiotics…) Use Subcutaneous: under the skin (insulin…) Intraarterial: into an artery (vasodilator drugs in the treatment of vasospasm…) Course Intradermal: into the skin itself (skin testing some allergens, tattoos…) 207 Transdermal: diffusion through the intact skin (transdermal opioid patches in pain management, nicotine patches for treatment of addiction…) Transmucosal:243/CENG diffusion through a mucous membrane (insufflation of cocaine) Inhalational: e.g. inhalational anesthetics NANO Drug Administration Routes - Summary Topical: Epicutaneous (allergy testing, local anesthesia…) Inhalational (asthma medications…) Only Eye drops (antibiotics for conjunctivitis…) Intranasal route (decongestant nasal sprays…) Use Enteral: any form of administration that involves any part of the gastrointestinal tract Oral (many drugs as tablets, capsules, drops…) Rectal (various drugs in suppository or enemaCourse form…) Gastric feeding tube (many drugs, enteral nutrition…) 207 Parenteral: Intravenous: into a vein (many drugs, total parenteral nutrition…) Intramuscular: into a muscle (many vaccines, antibiotic…) Subcutaneous: under the skin (insulin…) Intraarterial: into an artery (vasodilator drugs in the treatment of vasospasm…) Intradermal: into the skin itself (skin testing some allergens, tattoos…) Transdermal:243/CENG diffusion through the intact skin (transdermal opioid patches in pain therapy, nicotine patches for treatment of addiction…) Transmucosal: diffusion through a mucous membrane (insufflation of cocaine, NANOInhalational, e.g. inhalational anesthetics Novel Administration Routes Only Use Contact lenses for eye delivery Course 207 Controlled-release microchip Drug eluting stent 243/CENG Micro-needle patch NANO And many many more... Oral Administration stomach Advantages: Only duodenum Convenient - portable, no pain, easy to take. Use jejunum Cheap - no need to sterilize, compact, multi-dose bottles, produced in large quantities. ileum Variety - fast release tablets, capsules, enteric coated,Course layered tablets, slow release, suspensions, et al. 207 Disadvantages: Sometimes inefficient - high dose or low solubility drugs may suffer poor bioavailability. First-pass effect - drugs will be metabolized in the liver during absorption. Food - Food and GI243/CENG motility can effect drug absorption. Local effect - Antibiotics may kill normal gut flora and allow overgrowth of fungal varieties. UnconsciousNANO patient - Patient must be able to swallow solid dosage forms. Intravenous Injection Advantages: Rapid - A quick response is possible Only Total dose - The whole dose is delivered to the blood Use stream. Large doses can be given by extending the time of infusion. Veins insensitive - irritation by irritant drugs at higherCourse concentration in dosage forms. 207 Disadvantages: First intravenous injection (1667) Suitable vein - It may be difficult to find a suitable vein. Maybe toxic - Because of the rapid response, toxicity can be a problem. Requires trained243/CENG personnel - Trained personnel are required to give intravenous injections. Expensive - Sterility, pyrogen testing and large volume of solvent means great cost for NANOpreparation, transport and storage. Subcutaneous Injection Advantages: Only • Can be given by patient, e.g. in the case of insulin. Use • Absorption is slow but usually complete. Improved by massage or heat. Course Disadvantages: • Can be painful 207 • Irritant drugs can cause local tissue damage • Maximum of 2 mL injection thus often small doses limit use. 243/CENG NANO Intramuscular Injection Advantages: Only • Larger volume, than SC, can be given by IM. Use • A depot or sustained release effect is possible with IM injections. Course Disadvantages: • The site of injection will influence the absorption,207 generally the deltoid muscle is the best site. • Trained personnel required for injections. • Absorption is sometimes243/CENG erratic, especially for poorly soluble drugs. • The solvent maybe absorbed faster than the drug causing precipitation of the drug at the site of injection. NANO Inhalation Advantages: Only • By-passing the liver Use • Fastest method, 7-10 seconds for the drug to reach the brain • User can titrate (regulate the amount of drug they are receiving) Course Disadvantages: • Most addictive route of administration because207 it hits the brain so quickly • Difficulties in regulating the exact amount of dosage • Absorption of243/CENG gases is relatively efficient, but not solids or liquids NANO Only A Comparison of DifferentUse Administration Routes AdministrationCourse of Human Immunoglobulin G (IgG) 207 243/CENG IgG, ~150 kDa NANO Adapted from Lancet 1972, i, 1208 Drug Administered via Different Routes Will Have Different Consequences Only The route and method of drug administration will influence: Pharmacokinetics: what the body does to the drugUse Absorption Distribution Course Metabolism Excretion 207 Pharmacodynamics: what a drug does to the body Effectiveness of the drug 243/CENG NANO Intravenous Injection for Systemic Drug Delivery Only Use Notorious and fatal diseases usually require direct treatments with fast response and large dosage. Course 207 243/CENG NANO Only Use Course 207 Part II: Drug Transport by Fluid Motion 243/CENG NANO Basic Concept Diffusion: molecular movement within 100 µm; driven by Only concentration gradient Use Bulk flow & convection: long distance movement in the body; driven by hydrostatic and osmotic pressure Course 207 How blood flow is regulated? How to measure molecule concentration in blood? 243/CENG NANO 1. Blood Movement in the Circulating System Cylindrical vessel model Only Use r θ Course z 207 P: hydrostatic pressure V : fluid velocity along the z axis (function of radial distance from the tube centerline) z 243/CENG NANO Only 1. Blood MovementUse in the Circulating System Hagen -Poiseuille flow Course 207 243/CENG NANO Only 1. Blood MovementUse in the Circulating System Equation for conservation of momentum: Course 207 243/CENG Parabolic dependence of local NANOvelocity on radical position. 1. Blood Movement in the Circulating System Overall rate of blood flow Vessel cross sectionOnly Use dr dθ r Course Overall resistance of a cylindrical vessel to flow 207 When blood vessel243/CENG becomes smaller, the resistance to flow increases dramatically. The majority of the overall resistance to blood flow resides in the smallest vessels. NANO 1. Blood Movement in the Circulating System Blood supply to tissue Only Local blood flow to tissue is controlled by constriction and dilation of the arterioles delivering blood to the tissue. Use Individual arterioles have muscular walls which allow them to adjust their diameter, and hence resistance. Course 207 243/CENG NANO 1. Blood Movement in the Circulating System Flow distribution in branching networks can be regulated by resistance Only If one branch changes its resistance: Use R → ½ R Course One arteriole size drops by a factor of ½,207 Flow rate in the large artery drops to 81.25 mL/min 243/CENG NANO 1. Blood Movement in the Circulating System Efficient mixing Only For highly toxic drug (e.g., chemotherapy drug), they need to be injected to large vein/artery. Use - High flow velocity (15~20 cm/s) - Extensive branching of the cardiovascularCourse circuit 207 243/CENG NANO 2. Monitoring Drug/Nanoparticle Concentration in Blood (1) Radioisotope labeling Only e.g., docetaxel-loaded PLGA nanoparticles Use Docetaxel-14C (half-life: 5730 years) PLGA-3H (half-life: 12 years) e.g., liposomal nanoparticles CourseScience , 1994, 263, 160. lipid-chelated 111In (indium, 2.8 days)207 153Gd (gadolinium, 240 days) 45Ca (calcium, 163 days) 51Cr (chromium, 27 days) 32P (phosphorus, 14 days) 243/CENG109Cd (cadmium, 464 days) Advantages: trace amount; very accurate NANODisadvantages: dangerous; trained person 2. Monitoring Drug/Nanoparticle Concentration in Blood (2) Fluorescence labeling Only Challenge: interference from blood Solutions: (1) high loading of blue, green, or red probes Use (2) using far red fluorescent probes: Alexa 647, Cys 5.5, etc (3) No labeling Course Chemical characterization of drug/material207 itself. - high performance liquid chromatography (HPLC): UV absorbance - mass spectroscopy: elemental composition - electrochemical analysis: Redox reaction 243/CENG NANO .
Load more

Recommended publications
  • Effects of Intraoperative Insufflation with Warmed, Humidified CO2 During Abdominal Surgery: a Review
    Annals of Original Article Coloproctology Ann Coloproctol 2018;34(3):125-137 pISSN 2287-9714 eISSN 2287-9722 https://doi.org/10.3393/ac.2017.09.26 www.coloproctol.org Effects of Intraoperative Insufflation With Warmed, Humidified CO2 during Abdominal Surgery: A Review Ju Yong Cheong1,2, Anil Keshava1, Paul Witting2, Christopher John Young1 1Colorectal Surgical Department, Concord Repatriation General Hospital, Sydney Medical School, The University of Sydney, Sydney; 2Discipline of Pathology, Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, Australia Purpose: During a laparotomy, the peritoneum is exposed to the cold, dry ambient air of the operating room (20°C, 0%– 5% relative humidity). The aim of this review is to determine whether the use of humidified and/or warmed CO2 in the intraperitoneal environment during open or laparoscopic operations influences postoperative outcomes. Methods: A review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, OVID MEDLINE, Cochrane Central Register of Controlled Trials and Embase databases were searched for articles published between 1980 and 2016 (October). Comparative studies on humans or nonhuman animals that involved randomized controlled trials (RCTs) or prospective cohort studies were included. Both laparotomy and laparoscopic studies were included. The primary outcomes identified were peritoneal inflammation, core body temperature, and postoperative pain. Results: The literature search identified 37 articles for analysis, including 30 RCTs, 7 prospective cohort studies, 23 human studies, and 14 animal studies. Four studies found that compared with warmed/humidified CO2, cold, dry CO2 resulted in significant peritoneal injury, with greater lymphocytic infiltration, higher proinflammatory cytokine levels and peritoneal adhesion formation.
    [Show full text]
  • West Virginia Nerve Injury Slides
    Anesthesia for Robotic Surgery: Is it a Different Ball Game? Michael A. Olympio, M.D. Professor of Anesthesiology Wake Forest University School of Medicine YES, it is… Access to, and monitoring the patient Combined Pneumoperitoneum and Trendelenburg – Type and amount of inflation gas – Pulmonary impairments – Hydrostatic gradients – Cardiovascular derangements – Circulation to the lower limb – Confounding obesity Anesthetic adjuncts and outcomes – Routine general anesthesia – General and regional? – Multimodal, narcotic-sparing, “ideal” anesthetic Olympio, MA. “Anesthetic Considerations for Robotic Urologic Surgery” In, Hemal AK, Menon M (eds.) Robotic Urologic Surgery. New York: Springer-Verlag, 2011. Photo of RALRP At the end of this lecture, the learner will explain or understand: – the physiological derangements associated with combined pneumoperitoneum and Trendelenburg posture – the relationships between, and significance of hydrostatic pressure, blood pressure measurement and the risks of organ hypo/hyper-perfusion – the reasons for choosing specific anesthetic management techniques and drugs. No disclosures. What you should know about your own surgical outcomes: operative time nausea and vomiting rates blood loss use of intermittent morbidity types and rates pneumatic serial compression (IPSC) length of stay and criteria for discharge desired extremes of TP mortality (if any and its desired intra-abdominal cause) inflation pressures (IAP) postoperative pain and and, type of inflation gas analgesic regimens Pre-Anesthetic
    [Show full text]
  • I-Gel User Guide
    User Guide i-gel® single use supraglottic airway Adult and paediatric sizes www.i-gel.com Contents 1.0 Introduction .................................................................................................................... 2 1.1 The i-gel design ..................................................................................................................................................2 1.2 Key components and their function .........................................................................................................3 1.2.1 Soft non-inflatable cuff ................................................................................................................4 1.2.2 Gastric channel .............................................................................................................................4 1.2.3 Epiglottic rest ................................................................................................................................4 1.2.4 Buccal cavity stabiliser ................................................................................................................4 1.2.5 15mm connector ..........................................................................................................................5 1.2.6 Important key points.....................................................................................................................5 2.0 Indications .....................................................................................................................
    [Show full text]
  • Download the Evonik for More Information!
    ADVANCED APPROACHES THE PRESCRIPTION CAN WE ACHIEVE FOR DELAYED-RELEASE ABUSE EPIDEMIC: EFFECTIVE ORAL P04 FORMULATIONS P18 DESIGNING A SOLUTION P32 DELIVERY OF VACCINES? NOVEL ORAL DELIVERY SYSTEMS 77 O 2017 • ISSUE N 2017 TH JULY 17 JULY Contents o TH ONdrugDelivery Issue N 77, July 17 , 2017 Advanced Approaches for Delayed-Release Formulations Maria Montero Mirabet, Senior Project Manager, NOVEL ORAL DELIVERY SYSTEMS Drug Delivery Services, Business Line Health Care, and 4 - 9 Brigitte Skalsky, Senior Director, Scientific Communication, This edition is one in the ONdrugDelivery series Business Line Health Care of publications from Frederick Furness Publishing. Evonik Nutrition & Care Each issue focuses on a specific topic within the field of drug delivery, and is supported by industry Technologies & Clinical Studies for the Oral Delivery of Calcitonin Nozer Mehta, Principal leaders in that field. Peptide Technologies James P Gilligan, Chief Scientific Officer 12 MONTH EDITORIAL CALENDAR 10 - 16 Tarsa Therapeutics Sep Wearable Injectors William Stern, Consultant Peptide Drug Development Oct Prefilled Syringes Nov Pulmonary & Nasal Delivery The Prescription Abuse Epidemic: Designing a Solution Dec Connecting Drug Delivery Aia Malik, Healthcare Product Manager, and 18 - 20 Gemma Budd, Director of Technologies and Strategy Jan ‘18 Ophthalmic Delivery Lucideon Feb Prefilled Syringes Mar Skin Drug Delivery: Targeting the End Goal: Opportunities & Innovations in Colonic Drug Delivery Dermal, Transdermal & Microneedles Sejal R Ranmal, Director
    [Show full text]
  • Ozone in Medicine. the Low-Dose Ozone Concept and Its Basic Biochemical Mechanisms of Action in Chronic Inflammatory Diseases
    International Journal of Molecular Sciences Article Ozone in Medicine. The Low-Dose Ozone Concept and Its Basic Biochemical Mechanisms of Action in Chronic Inflammatory Diseases Renate Viebahn-Haensler 1,*,† and Olga Sonia León Fernández 2,*,† 1 Medical Society for the Use of Ozone in Prevention and Therapy, Iffezheim, D-76473 Baden-Baden, Germany 2 Pharmacy and Food Institute, University of Havana, Coronela, Lisa, Havana 10 400, Cuba * Correspondence: [email protected] (R.V.-H.); [email protected] (O.S.L.F.) † Both authors contributed equally. Abstract: Low-dose ozone acts as a bioregulator in chronic inflammatory diseases, biochemically char- acterized by high oxidative stress and a blocked regulation. During systemic applications, “Ozone peroxides” are able to replace H2O2 in its specific function of regulation, restore redox signaling, and improve the antioxidant capacity. Two different mechanisms have to be understood. Firstly, there is the direct mechanism, used in topical treatments, mostly via radical reactions. In systemic treatments, the indirect, ionic mechanism is to be discussed: “ozone peroxide” will be directly reduced by the glutathione system, informing the nuclear factors to start the regulation. The GSH/GSSG balance outlines the ozone dose and concentration limiting factor. Antioxidants are regulated, and in the case of inflammatory diseases up-regulated; cytokines are modulated, here downregulated. Rheumatoid Citation: Viebahn-Haensler, R.; arthritis RA as a model for chronic inflammation: RA, in preclinical and clinical trials, reflects the León Fernández, O.S. Ozone in pharmacology of ozone in a typical manner: SOD (superoxide dismutase), CAT (catalase) and finally Medicine. The Low-Dose Ozone GSH (reduced glutathione) increase, followed by a significant reduction of oxidative stress.
    [Show full text]
  • Cough Assist Machine" SW3 6NP UK Fax: 44 2073518911 Educational Aims E-Mail: [email protected]
    Breathe review cough.qxd 21/05/2008 16:06 Page 2 Key points k Ineffective cough is a major cause of mortality and morbidity in patients with neuromuscular disease. k A normal cough requires the inspiratory muscles to inspire to up to 85–90% of total lung capacity followed by rapid closure of the glottis for ~0.2 s. Both glottic opening and contraction of abdominal and intercostal (expiratory) muscles, resulting in intrapleural pressures of >190 cmH2O and generating transient peak cough flows (PCF) of 360–1,200 L per min [1] complete the manoeuvre. k Cough assist techniques are used in patients who present with a weak cough. The goal of these techniques is to increase the expiratory airflow that occurs during a cough, by assist- ing inspiration and/or expiration, thus increasing cough efficacy. k When conventional cough assistance techniques become ineffective, a mechanical insufflator–exsufflator should be considered. Breathe review cough.qxd 21/05/2008 16:06 Page 3 The ERS designates this educational activity for a maximum of 1 CME credit. For information on how to earn CME credits, see page 375 How to use a mechanical M. Chatwin Sleep and Ventilation Unit insufflator–exsufflator Royal Brompton Hospital Sydney Street London "cough assist machine" SW3 6NP UK Fax: 44 2073518911 Educational aims E-mail: [email protected] k To raise awareness of how to use mechanical insufflator–exsufflators. k To discuss the use of mechanical insufflation–exsufflation compared with conventional airway clearance techniques. Support statement k To identify an escalation treatment protocol. M. Chatwin was funded by grants from the Jennifer Trust for Spinal Muscular Atrophy (UK) and Breas Summary Medical (Sweden) Effective cough is a protective mechanism against respiratory tract infections.
    [Show full text]
  • An Introduction to Anaesthesia
    What You Need to KNoW about An introduction to anaesthesia Introduction divided into three stages: induction, main- n Central neuraxial block, e.g. spinal or Anaesthetic experience in the undergradu- tenance and emergence. epidural (Figure 1 and Table 1). ate timetable is often very limited so it can In regional anaesthesia, nerve transmis- remain somewhat of a mysterious practice sion is blocked, and the patient may stay Components of a general well into specialist training. This introduc- awake or be sedated or anaesthetized dur- anaesthetic tion to the components of an anaesthetic ing a procedure. Techniques used include: A general anaesthetic always involves an will help readers to get more from clinical n Local anaesthetic field block hypnotic agent, usually an analgesic and attachments in surgery and anaesthetics or n Peripheral nerve block may also include muscle relaxation. The serve as an introduction to the topic for n Nerve plexus block combination is referred to as the ‘triad of novice or non-anaesthetists. anaesthesia’. Figure 1. Schematic vertical longitudinal section The relative importance of each com- Types and sites of anaesthesia of vertebral column and structures encountered ponent depends on surgical and patient The term anaesthesia comes from the when performing central neuraxial blocks. * factors: the intervention planned, site, Greek meaning loss of sensation. negative pressure space filled with fat and surgical access requirement and the Anaesthetic practice has evolved from a venous plexi. † extends to S2, containing degree of pain or stimulation anticipated. need for pain relief and altered conscious- arachnoid mater, CSF, pia mater, spinal cord The technique is tailored to the individu- ness to allow surgery.
    [Show full text]
  • Aerosol Delivery Devices
    Year in Review 2014: Aerosol Delivery Devices Timothy R Myers MBA RRT-NPS FAARC Introduction History and Rationale Patient-Related Variables Pediatrics Patient Interfaces Delivery to Patients Requiring Mechanical Support Emerging Technologies Summary After centuries of discoveries and technological growth, aerosol therapy remains a cornerstone of care in the management of both acute and chronic respiratory conditions. Aerosol therapy em- braces the concept that medicine is both an art and a science, where an explicit understanding of the science of aerosol therapy, the nuances of the different delivery devices, and the ability to provide accurate and reliable education to patients become increasingly important. The purpose of this article is to review recent literature regarding aerosol delivery devices in a style that readers of RESPIRATORY CARE may use as a key topic resource. Key words: aerosol; delivery device; MDI; DPI; nebulizer; valved holding chamber; pediatrics; positive expiratory pressure; aerosol mask; high-flow cannula; noninvasive ventilation; mechanical ventilation. [Respir Care 2015;60(8):1190–1196. © 2015 Daedalus Enterprises] Introduction ications delivered through the inhalational route require specialized delivery systems to ensure delivery, deposi- The prevalence of respiratory conditions continues to tion, and accurate dosage.1 grow with each passing year. Regardless of the specific disease etiology, acute and chronic respiratory conditions History and Rationale require medical treatment either in the short term or on a continual, ongoing basis. One of the therapeutic similari- Aerosol delivery devices consist largely of small-vol- ties for all acute and chronic diseases is the necessity for ume nebulizers, pressurized metered-dose inhalers, and dry treatment/management with medication.
    [Show full text]
  • Routes of Opioid Abuse and Its Novel Deterrent Formulations
    evelo f D pin l o g a D Omidian et al., J Develop Drugs 2015, 4:5 n r r u u g o s J Journal of Developing Drugs DOI: 10.4172/2329-6631.1000141 ISSN: 2329-6631 Review Article Open Access Routes of Opioid Abuse and its Novel Deterrent Formulations Omidian A1, Mastropietro DJ2 and Omidian H2* 1The University of Chicago, Chicago, IL, USA 2College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA Abstract This review aimed to investigate the abuse patterns of common prescription opioids currently on the market by collecting large-scale surveys of different abuser populations. Furthermore, we aimed to analyze the efficacy and properties of currently implemented abuse-deterrent formulations (ADF) for these compounds. Our investigation showed that while oxycodone and oxymorphone are primarily abused by oral ingestion and insufflations, respectively, their ADF products (reformulated OxyContin and Opana ER) show some encouraging results to deter their abuse. Tapentadol is not popular amongst abuser populations, its ADF are difficult to tamper with, and it does not produce significantly desirable effects in noncompliant patients when compared to other opioids. Hydromorphone is predominantly abused by injection, and any effective abuse-deterrent strategy must specifically prioritize and target this route. Current formulations have successfully conferred aversive properties onto the drug in the event of preparation for injection, yet overall rates of hydromorphone abuse remain high, suggesting that more innovative steps need to be taken. Despite novel deterrent technologies that collectively offer deterrence by insufflations, injection and co-ingestion with alcohol, more priority needs to be given to deterring the most common and accessible route of abuse, i.e., oral ingestion of multiple doses.
    [Show full text]
  • The Pharmacokinetics of Drug Use Are Decisive in Addiction
    How fast and how often: The pharmacokinetics of drug use are decisive in addiction Florence Allain a, Ellie-Anna Minogianis a, David C.S. Roberts b, Anne-Noël Samaha a,c,∗ a Department of Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada H3C 3J7 b Department of Physiology and Pharmacology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA c CNS Research Group, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada H3C 3J7 ∗ Corresponding author at: Université de Montréal, Department of Pharmacology, Faculty of Medicine, Montreal, QC, Canada H3C 3J7. Tel.: +1 514 343 6111x32788; fax: +1 514 343 2291. E-mail address: [email protected] (A.-N. Samaha). Abstract How much, how often and how fast a drug reaches the brain determine the behavioural and neuroplastic changes associated with the addiction process. Despite the critical nature of these variables, the drug addiction field often ignores pharmacokinetic issues, which we argue can lead to false conclusions. First, we review the clinical data demonstrating the importance of the speed of drug onset and of intermittent patterns of drug intake in psychostimulant drug addiction. This is followed by a review of the preclinical literature demonstrating that pharmacokinetic variables play a decisive role in determining behavioural and neurobiological outcomes in animal models of addiction. This literature includes recent data highlighting the importance of intermittent, ‘spiking’ brain levels of drug in producing an increase in the motivation to take drug over time. Rapid drug onset and intermittent drug exposure both appear to push the addiction process forward most effectively.
    [Show full text]
  • Anesthesia for Video-Assisted Thoracoscopic Surgery
    23 Anesthesia for Video-Assisted Thoracoscopic Surgery Edmond Cohen Historical Considerations of Video-Assisted Thoracoscopy ....................................... 331 Medical Thoracoscopy ................................................................................................. 332 Surgical Thoracoscopy ................................................................................................. 332 Anesthetic Management ............................................................................................... 334 Postoperative Pain Management .................................................................................. 338 Clinical Case Discussion .............................................................................................. 339 Key Points Jacobaeus Thoracoscopy, the introduction of an illuminated tube through a small incision made between the ribs, was • Limited options to treat hypoxemia during one-lung venti- first used in 1910 for the treatment of tuberculosis. In 1882 lation (OLV) compared to open thoracotomy. Continuous the tubercle bacillus was discovered by Koch, and Forlanini positive airway pressure (CPAP) interferes with surgi- observed that tuberculous cavities collapsed and healed after cal exposure during video-assisted thoracoscopic surgery patients developed a spontaneous pneumothorax. The tech- (VATS). nique of injecting approximately 200 cc of air under pressure • Priority on rapid and complete lung collapse. to create an artificial pneumothorax became a widely used • Possibility
    [Show full text]
  • Development of an Intraperitoneal Catheter Placement Device for Use on the Battlefield
    University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Mechanical (and Materials) Engineering -- Mechanical & Materials Engineering, Dissertations, Theses, and Student Research Department of 5-2021 Development of an Intraperitoneal Catheter Placement Device for Use on the Battlefield Riley Reynolds University of Nebraska-Lincoln, [email protected] Follow this and additional works at: https://digitalcommons.unl.edu/mechengdiss Part of the Biomedical Devices and Instrumentation Commons, Materials Science and Engineering Commons, and the Mechanical Engineering Commons Reynolds, Riley, "Development of an Intraperitoneal Catheter Placement Device for Use on the Battlefield" (2021). Mechanical (and Materials) Engineering -- Dissertations, Theses, and Student Research. 164. https://digitalcommons.unl.edu/mechengdiss/164 This Article is brought to you for free and open access by the Mechanical & Materials Engineering, Department of at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Mechanical (and Materials) Engineering -- Dissertations, Theses, and Student Research by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. DEVELOPMENT OF AN INTRAPERITONEAL CATHETER PLACEMENT DEVICE FOR USE ON THE BATTLEFIELD By Riley Reynolds A THESIS Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Master of Science Major: Mechanical Engineering and Applied Mechanics Under the Supervision of Professor Benjamin S. Terry Lincoln, Nebraska May 2021 DEVELOPMENT OF AN INTRAPERITONEAL CATHETER PLACEMENT DEVICE FOR USE ON THE BATTLEFIELD Riley Reynolds, M.S. University of Nebraska, 2021 Adviser: Benjamin Terry The objective of this project was to simplify peritoneal cavity access so an Airforce field medic can safely infuse oxygen microbubbles (OMBs) into the intraperitoneal space for the emergency treatment of hypoxia due to lung damage.
    [Show full text]