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Drug Therapy in Laryngology and Head and Neck Surgery
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
These are divided into cough suppressants and the expectorant and demulcent cough preparations. After excluding an underlying cause of a cough, such as asthma and gastro-oesophageal reflux, cough suppressants may be used. It is thought that these drugs act by an ill-defined central action in the nervous system and may depress the ‘cough centre’ in the brain stem. The narcotic analgesics are effective as antitussives in subanalgesic doses. Codeine phosphate is useful for dry or painful coughs but it also inhibits the secretion and mucociliary clearance of sputum, is constipating and dependence can develop. Pholcodine (related to codeine) and dextromethorphan (a non-narcotic, nonanalgesic) have lesser side effects. Over the counter preparations include sedating antihistamines, such as diphenhydramine, and may work by causing drowsiness.
Pitfalls and Practical Solutions
Published in Joseph Chamberlain, The Analysis of Drugs in Biological Fluids, 2018
Although not strictly an extraction cartridge, dialysis units have been used for sample pretreatment and included in-line with liquid chromatography systems. For example. Van de Merbel et al. described such a system for the analysis of benzodiazepines in plasma. In this method 100 μl plasma was dialyzed for 7.6 min against a chosen acceptor at a flow rate of 3 ml min−1, then concentrated in a more conventional precolumn before analysis by HPLC. Andresen et al.1461 also used a predialysis step for the HPLC analysis of pholcodine in human plasma and in whole blood.
Saliva Drug Analysis
Published in Steven H. Y. Wong, Iraving Sunshine, Handbook of Analytical Therapeutic Drug Monitoring and Toxicology, 2017
Edward J. Cone, Amanda J. Jenkins
Pholcodine is a codeine-like antitussive that is readily available in many countries. Chen et al.112 reported its detection by high-performance liquid chromatography in saliva and plasma of a young male volunteer after oral administration of 60 mg of pholcodine. Saliva contained approximately three times the amount of pholcodine found in plasma, and this ratio seemed to be relatively stable during the elimination phase. Urine concentrations of drug were substantially higher than saliva and plasma concentrations. Terminal half-lives calculated from the three biological fluids were similar and averaged 48.6 hr.
What do we know about perioperative hypersensitivity reactions and what can we do to improve perioperative safety?
Published in Annals of Medicine, 2021
Urszula Kosciuczuk, Pawel Knapp
The results of epidemiological analyses have set the directions of medical activities and have changed the rules and recommendations [40–43]. The NAP 6 project reported that 38% of anaesthesiologists believed neuromuscular blocking agents to be primary causative agents, and 30% of them avoid succinylcholine and rocuronium for this reason [7,8]. The Australian and European Urological Society suggested avoiding chlorhexidine use in urethral gels. Due to the increasing share of disinfectants and sensitisation with the use of pholcodine, the authors indicate the need to increase awareness of this phenomenon in medical activity, as well as to monitor pholcodine availability. The Australian and New Zealand Anaesthetic Allergy Group and Norwegian Network for Anaphylaxis during Anaesthesia have restricted pholcodine prescriptions and general availability. Epidemiological data obtained after 3 years of limitations on the pholcodine availability in Norway presented a significant reduction in sensitisation state. The concentration of serum antibodies was reduced from 11% to 2.7% for pholcodine, from 3.7% to 0.3% for succinylcholine, and from 10% to 1.3% for morphine, respectively. Moreover, it was associated with a reduced number of reported hypersensitivity reactions to muscle relaxants from 56 cases in 2007 to 34 cases in 2009, also. Although latex hypersensitivity reactions have not been reported in epidemiological studies in recent years, there is still a need to monitor [44].
Rocuronium anaphylaxis in a 7-year-old boy during the induction of anesthesia
Published in Immunological Medicine, 2018
Yoshiko Morimoto, Sakiko Satake, Aguri Kamitani, Manabu Yamada, Mutsumi Saitou, Yuki Torii, Rokuro Shiba, Chika Hadase, Toru Yamamoto
NMBA-induced anaphylaxis had been thought to be associated with NMBA-specific IgE mediating degranulation of mast cells. This had been considered to be due to common substituted ammonium ions (tertiary and/or quaternary NH4+) which are found in a variety of chemicals, including cosmetics, shampoo, toothpaste, and cough suppressant pholcodine. According to this concept, a possible explanation for an IgE-mediated reaction upon first exposure to NMBA could be cross-reactivity among NMBA and these chemicals. However, it has been shown that withdrawal of one such drug pholcodine was associated with decrease of total IgE levels, supporting the idea that such a compound might be a potent ‘polysensitizer’ and may elicit NMBA sensitization by another mechanism than by sharing a common epitope [5]. IgE-dependency-based theory has not been able to fully explain the high rate of anaphylactic reactions upon the first exposure as well as the high rate of cross-sensitization demonstrated by various NMBA. In addition, many rocuronium IgE positive cases have negative skin test reactivity to rocuronium [6] and some of these patients can safely receive rocuronium [7].