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Medicines management
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Kirsty Andrews, Martina O’Brien
Otherwise, needles are selected according to the route and sometimes according to the body adipose of the person. For example, for an intramuscular injection, if there is a large amount of adipose, a longer needle will be required to ensure the drug enters the muscle. Nurses sometimes underestimate the required needle length by trying to be kind but using too short a needle means that the drug does not enter the muscle (Shepherd 2018a).
Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
An important factor influencing absorption of drugs from an intramuscular injection site is the blood flow to and from the injection site. This may be compromised in newborns with poor peripheral perfusion from low cardiac output states or the respiratory distress syndrome [30]. The rate and extent of absorption from an intramuscular injection site are also influenced by the total surface area of muscle coming into contact with the injected solution [15]. The ratio of skeletal muscle mass to body mass is less for neonates than for adults [30]. However, the impact of these factors may be offset by the increase in skeletal muscle capillary density observed in infants as compared to older children [31]. Accordingly, evidence supports more efficient intramuscular drug absorption and higher peak plasma concentrations for a number of agents (e.g., antibiotics and anticonvulsants) in neonates and infants as compared to adults [32,33].
Battlefield Chemical Inhalation Injury
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Inhalational and systemic exposures could be treated by parenteral use of BAL as well (10% in oil). Suggested dose (by deep intramuscular injection) is 0.02 ml/lb up to 4 ml maximum given every 4 hr for a total of four doses. In dog studies, earlier injections are more beneficial, with virtual absence of effect 90 min after exposure (Harrison, 1944).
An evaluation of long-acting cabotegravir + rilpivirine for the treatment of virologically suppressed adults living with HIV
Published in Expert Opinion on Pharmacotherapy, 2022
Hamdi Qazzaz, Christopher Parganas, Theodore James Cory
Long-acting injectable products may have advantages as compared to traditional antiretroviral therapy strategies. The non-inferiority clinical trials including LATTE, LATTE-2 and ATLAS, coupled with high patient satisfaction scores, suggests that these approaches are safe, efficacious, and well tolerated. A potential niche of therapy for CAB+RPV is in patients that may benefit from an extended dosing interval product. Patients with adherence concerns, such as those who work long hours or who struggle with remembering to take daily medications would be significantly impacted by long-acting formulations. In addition, patients who experienced side effects from oral medications would also benefit from therapy that bypasses first pass metabolism or presystemic circulation. The intramuscular injection has a significant advantage in this subpopulation due to controlled administration at the clinician level. The benefits allow for increased dosing schedules for patients and allow for structured and atypical dosing schedules to fit the needs of patients who cannot be maintained on a fixed oral dosing regimen.
Evaluation of aqueous dimethyl trisulfide as an antidote to a highly lethal cyanide poisoning in a large swine model
Published in Clinical Toxicology, 2022
Tara B. Hendry-Hofer, Carter C. Severance, Subrata Bhadra, Patrick C. Ng, Kirsten Soules, Dennean S. Lippner, Diane M. Hildenberger, Melissa O. Rhoomes, Jessica N. Winborn, Brian A. Logue, Gary A. Rockwood, Vikhyat S. Bebarta
Based on previous dose optimization data, this study focused on a one-time IM dose (10 mg/kg, ∼5 ml injection volume) of DMTS. While this dose proved to be efficacious, 5 ml is the maximum volume recommended for a single intramuscular injection in adults. In its current formulation it is possible two intramuscular injections with DMTS would be required to rescue an adult human. However, administering two intramuscular injections is simpler than attempting to obtain intravenous access following a large-scale exposure with multiple victims. Furthermore, it is likely the injection volume could be decreased with symptom-based repeat dosing, similar to what is recommended with intravenous, FDA-approved antidotes [31,32]. It is also possible utilization of an autoinjector versus standard needle and syringe would require less volume [33]. Furthermore, alternative administration routes (e.g., intranasal, oral) should also be explored.
Fatal and life-threatening ADRs associated with paliperidone palmitate: an observational study in the French pharmacovigilance database
Published in Clinical Toxicology, 2021
D. Boels, J. Mahé, A. Olry, A. Citterio-Quentin, J. Moragny, P. Jolliet
On the basis of PK modeling data, because of their extremely low water solubility (log p≈8), PP particles in the suspension slowly dissolve into the local fluids at the injection site, and they gradually enter systemic circulation after hydrolysis. Several PK studies suggest that the rate-limiting factor is PP dissolution at the injection site. The median peak concentration and AUC can vary noticeably between injection site: in one study, after second administration, PP exposure was approximately 45% higher for deltoid injection than for gluteal injection, and approximately 25% higher after fourth administration [6,28]. In our series, injection site was not reported. This observed variation between injection sites can be explained by the distribution of muscle and adipose tissue, which condition plasma paliperidone uptake. True intramuscular injection is more likely for deltoid injection sites. The hypovascularity of subcutaneous adipose tissue relative to muscle tissue may result in a slower plasma uptake of paliperidone. Furthermore, the hydrolyzing capacities of each tissue probably differ, and this may affect paliperidone pharmacokinetics (i.e., Cmax, tmax, and AUC). There is still a lack of consensus on the bioequivalence of the two administration sites: doubt remains as to the risk (especially of supratherapeutic concentrations) posed by site switching [29]. Further investigation of this question may be warranted.