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Preparing the Malnourished Patient for Parenteral Nutrition (PN)
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Parenteral nutrition -related risks occur in two major groups: on initiation and during ongoing therapy. The risks of initiation are related to the metabolic, electrolyte and fluid shifts that occur with nutritional repletion in a malnourished patient. The most serious of these are the refeeding syndrome and Wernicke's Encephalopathy (WE). But significant electrolyte imbalances, volume overload and glucose imbalances should be expected in the early phase of parenteral nutrition.
Analgesics during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Acute narcotic analgesic therapy is most commonly indicated for postoperative pain relief. Women who require surgery during pregnancy can be safely treated for acute pain relief with a variety of analgesic agents for postoperative pain with relative safety for the fetus. Two commonly used regimens are meperidine (Demerol), 50–100 mg IM every three to four hours, or hydromorphone (Dilaudid), 1–2 mg every three to four hours. Caution should be exercised with large doses during breastfeeding. Dosage regimens for various parenteral preparations are summarized in Table 8.3.
Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Most NSAIDs are given orally or rectally. After oral administration they are rapidly absorbed from the upper GI tract, primarily from the stomach, and peak plasma concentrations are usually reached in about two hours. Some (for example, ketorolac, tenoxicam, diclofenac, and ibuprofen) can be given by injection. Oral administration is very effective, and there is little evidence that other routes offer significant advantages in terms of analgesic efficacy or side effects, except in treatment of acute renal colic (Schug et al, 2020). However, parenteral administration permits use in patients who are unable to take oral medications.
Role of nanotechnology in the prolonged release of drugs by the subcutaneous route
Published in Expert Opinion on Drug Delivery, 2023
The parenteral route of administration can be subdivided into three primary modalities: intramuscular (IM), intravenous (IV), and subcutaneous (SC), and is the most commonly used route for drugs when per os administration is not available. This route of administration has many advantages, including first-pass metabolism effect avoidance, high bioavailability, and reliable pharmaceutical dosage forms [1]. It can be the preferred route in emergencies or for noncooperative patients; however, not all parenteral routes provide the same onset of action, as the IV route provides direct access to the systemic circulation. In contrast, the IM and SC routes can promote slow drug release based on their anatomy and physiology [1]. Nevertheless, as SC tissue has fewer blood vessels than muscle tissue compared with the IM route, it can provide a better prolonged effect on drug release [2].
Development of a telematic pharmaceutical care app (Haemoassist) for multidisciplinary follow-up of patients with congenital coagulopathies
Published in Expert Review of Hematology, 2023
Nuria Blazquez-Ramos, José A. Romero-Garrido, Luis Gonzalez Del Valle, Victoria L. Collada-Sanchez, María Teresa Alvarez-Roman, Victor Jimenez-Yuste, Monica Martin-Salces, Hortensia De la Corte-Rodriguez, Alicia Herrero-Ambrosio, Juana Benedi-Gonzalez, E. Carlos Rodriguez-Merchan
The possibility for these patients to self-administer their medication at home has led to a clear improvement in both disease control and quality of life [15]. Home treatment in these pathologies displays a series of characteristics that differentiate it from self-treatment for other diseases: a) Parenteral administration is mostly intravenous, although subcutaneous administration has recently emerged, which is simpler. This method requires exhaustive patient or caregiver training and monitoring of how the technique is being performed [5], b) and the cost of the treatment is high, making it necessary to control its rational use [6]. However, most patients reach a degree of autonomy that allows them to perform the following: a) administer prophylactic doses according to the schedule set by their specialist and according to pharmacokinetic studies, b) administer additional or extra doses when they are going to perform activities that entail an increased risk of bleeding, and c) identify mild bleeding and treat it at home without medical supervision. However, these new approaches make it difficult for healthcare professionals to know exactly how the patient has used the treatments. This patient independence presents a challenge to healthcare professionals in terms of their awareness of how many hemorrhages the patient has had and whether the patient recognizes and treats them appropriately.
Preparation and characterization of nanocochelate by using phosphatidylcholine as lipid carrier for enhancement of permeability and bioavailability of rosuvastatin
Published in Drug Development and Industrial Pharmacy, 2021
Ashish Yashwantrao Pawar, Sagar S. Patil, Prajakta S. More, Pallavi R. Jadhav, Snehal R. Bhavar
Since poor water solubility correlates with slow dissolution rate, Elan's formulation approach increases the drug's surface area by reducing particle size, leading to an increase in dissolution rate. This is accomplished with Nano Crystal particles, which are typically less than 1,000 nanometers in diameter and are produced by milling the drug substance using Elan's wet-milling technique. The NanoCrystal particles of the drug are stabilized against agglomeration by surface adsorption of selected GRAS (Generally Regarded As Safe) stabilizers, so the result is an aqueous dispersion of the drug substance that behaves like a solution, a Nano Crystal colloidal dispersion, which can be processed into finished dosage forms for all routes of administration. The technology can be incorporated into all dosage forms, either parenteral and oral, including solid, liquid, fast-melt, pulsed release and controlled release dosage forms. Elan also has a pact with Abbott and AstraZeneca to use the NanoCrystal technology in developing a combination product of fenofibrate and AstraZeneca's (London) ‘Crestor’ (rosuvastatin) [30].