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Anesthesia for Patients with Ventricular Assist Devices
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
Due to the severity of hemodynamic instability and the individual patient response, induction of anesthesia is often initiated with titrated doses of opioids. Fentanyl citrate (10–20 μg/kg IV) along with a hypnotic drug such as etomidate (0.1–0.3 mg/kg IV) can be used during induction. An alternative is ketamine hydrochloride. End organ unresponsiveness due to depletion of myocardial catecholamines and beta receptor down regulation can unmask ketamine hydrochloride’s direct negative inotropic effect. If ketamine hydrochloride is chosen a dose of 0.5–1 mg/kg should be titrated intravenously. To facilitate tracheal intubation nondepolarizing muscle relaxants are used. Many of the patients who require VAD(s) implantation have impaired renal function and in these cases cisatracurium besylate is used. If renal function is preserved then rocuronium bromide (0.05 mg/kg) or vecuronium bromide is acceptable.
Disposition and Metabolism of Drugs of Dependence
Published in S.J. Mulé, Henry Brill, Chemical and Biological Aspects of Drug Dependence, 2019
Diazepam (Valium®) was synthesized in 1959. It is a crystalline solid m. 125 to 126°C. Its hydrochloride salt is soluble in water. It is used as a tranquilizer and skeletal muscle relaxant. Oral dose as a tranquilizer ranges from 2 mg to 10 mg per day with wide variation in dosage depending on the patient.
Resuscitation Physiology
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Dopamine hydrochloride is a chemical precursor, of noradrenaline, that stimulates dopaminergic, β1-adrenergic and α-adrenergic receptors in a dose dependent fashion. Low doses of dopamine (<3 μg/kg/min) produce cerebral, renal, and mesenteric vasodilatation, and venous tone is increased. Urine output is increased, but there is no evidence to show that this is in any way protective to the kidneys.
Novel and emerging therapeutics for genetic epilepsies
Published in Expert Review of Neurotherapeutics, 2021
Ana Pejčić, Slobodan M. Janković, Miralem Đešević, Refet Gojak, Snežana Lukić, Nenad Marković, Miloš Milosavljević
Clemizole hydrochloride (EPX-100) is a first-generation antihistamine that was used in the therapy of itchiness [88]. The anticonvulsant effect of clemizole and its derivates were discovered in experimental in vivo studies on scn1Lab mutant zebrafish models of Dravet syndrome [95,122,123]. The mechanism of action by which clemizole reduces the frequency of seizures is similar to fenfluramine and is most likely the result of modulation of 5-HT2B receptors and stimulation of serotoninergic transmission in the brain [123]. The pharmacokinetics and safety of clemizole hydrochloride were tested in a phase I, placebo-controlled, double-blind, 2-period study (NCT04069689) in three sequential groups of eight healthy subjects each [124]. Six participants in each group received clemizole hydrochloride at three different doses (20, 40, or 80 mg), while the other two participants received a placebo [124,125]. The study was completed in January 2020 and the results showed that it was well-tolerated by both male and female participants [88,125]. After the completion of the first phase of the clinical trial, a phase II multicenter, randomized, double-blind, placebo-controlled study (NCT04462770) began in late 2020 [126]. The efficacy of clemizole hydrochloride as adjunctive therapy will be assessed in 24 patients with Dravet syndrome, 2–17 years old with documented genetic mutations of SCN1A gene [126]. The study will have a 4-week observational period, 4-week titration period, and 12-week maintenance period [126].
Acetaminophen and tramadol hydrochloride-loaded soft gelatin capsule: preparation, dissolution and pharmacokinetics in beagle dogs
Published in Pharmaceutical Development and Technology, 2021
Tramadol is a centrally acting synthetic opioid medication with monoaminergic actions similar to serotonin-norepinephrine reuptake inhibitors (Miotto et al. 2017). It is considered as an first member of the ‘atypical opioids’ group with the pharmacodynamics drug effect district to those of the more classic opioids (Bravo et al. 2017). It has been marketed as a hydrochloride salt; moreover, it is available in injectable, oral, and rectally administered preparations. With an onset time of 1 h and Tmax of 2 h, it is well-absorbed in the gastrointestinal tract and then metabolized in the liver with the participation of cytochrome P450 (Siepsiak et al. 2019). Tramadol is used as a pain reliever for various acute or chronic diseases. However, for some diseases, other analgesics are being used due to the slow onset time of tramadol (Shipton 2000). For the treatment of cancer pain, in the initial treatment, morphine has been more effective for severe cancer pain which may reflect tramadol’s slower onset (Bamigbade and Langford 1998).
Factors associated with the absence of cocaine craving in treatment-seeking individuals during inpatient cocaine detoxification
Published in The American Journal of Drug and Alcohol Abuse, 2021
Jose Pérez de los Cobos, Saul Alcaraz, Antonio Verdejo-García, Laura Muñoz, Núria Siñol, Maria José Fernández-Serrano, Pilar Fernández, Ana Martínez, Santiago Duran-Sindreu, Francesca Batlle, Joan Trujols
This study has three main limitations. First, we cannot rule out limitations in detecting craving absence. To achieve a balance between sensitivity and specificity to detect naturally-occurring craving, we asked patients to indicate the intensity and frequency of any desire or urge for cocaine experienced during the last 24 h on two instruments (modified VAS), both of which are included in a specific tool (the CSSA) designed to assess cocaine withdrawal. More research is needed to determine whether other approaches to measuring cocaine craving – that is, in terms of complexity and frequency of assessment – would yield similar findings to those obtained in this study. Second, despite the relevance of cocaine withdrawal for cocaine craving during detoxification, this variable was not included among the candidate predictors of absence of craving because we are not aware of any validated cocaine withdrawal assessment instrument that does not include craving as one of the items. Finally, the findings of this study may not be applicable to patients who predominantly use cocaine-free base (inhaled) or intravenous cocaine hydrochloride rather than intranasal cocaine hydrochloride (as was the case for the participants in this study) given the relevance of recent cocaine exposure for absence of craving.