Identification of potentially irritating intravenous medications.

AIMS: To identify commonly used intravenous drugs that may produce endothelial damage. METHODS: An experimental research study was performed using a sample of 62 intravenous drugs commonly used in emergency care, pH and osmolarity were measured. Subsequently, based on these values, the theoretical capacity to cause irritation or endovascular damage was determined and classified as high, moderate, and low. RESULTS: Samples from 19 drugs for fluid therapy, 21 antibiotics and 22 drugs for intravenous use were studied. Glucose solutions, sodium bicarbonate 1M and mannitol 10% showed a high capacity to cause venous irritation. Vancomycin, ciprofloxacin, amiodarone, haloperidol, and labetalol solution presented a high capacity for irritation based on their acidic pH. The antibiotics, dexketoprofen, diazepam, digoxin, etomidate, phenytoin, levetiracetam and metamizole also showed high osmotic values in their reconstituted or undiluted presentations. Moreover, osmolarity of diazepam, digoxin and phenytoin remained high despite being diluted in 100 ml of saline. CONCLUSIONS: Knowing the pH and osmolarity of intravenous drugs allows their capacity to cause endothelial damage to be assessed. The use of comprehensive tables based on the chemical properties of the drugs can be a useful tool to help prevent chemically-induced phlebitis.

Identificación de medicamentos intravenosos potencialmente irritantes / Identification of potentially irritating intravenous medications

Objetivos: Identificar los medicamentos intravenosos de uso común en el ámbito hospitalario con capacidad de producir daño endotelial. Método: Estudio experimental in vitro. La muestra estuvo formada por 62 medicamentos de uso común en los servicios de urgencias y hospitalización. Las variables estudiadas fueron la osmolaridad y el pH. Posteriormente, en base a esos valores, se determinó la capacidad teórica para provocar daño endotelial, clasificándola en alta, moderada y baja. Resultados: Se analizaron 19 medicamentos para fluidoterapia, 21 antibióticos y 22 medicamentos intravenosos. Las soluciones de glucosa, el bicarbonato 1M y el manitol 10% presentaron una capacidad elevada para provocar irritación venosa. Vancomicina, ciprofloxacino, amiodarona, haloperidol y labetalol mostraron una capacidad irritativa elevada derivada de su pH marcadamente ácido. Los antibióticos, dexketoprofeno, diazepam, digoxina, etomidato, fenitoína, levetiracetam y metamizol presentaron valores extremos de osmolaridad en su presentación reconstituida o sin diluir, y mantuvieron sus valores de tonicidad elevados después de diluirlos en 100ml de suero salino el diazepam, la digoxina y la fenitoína. Conclusiones: Conocer el pH y la osmolaridad de los medicamentos intravenosos permite evaluar su capacidad para provocar daño endotelial. La creación de tablas comprensivas en base a las propiedades químicas de los medicamentos puede constituir una herramienta útil que contribuya a prevenir la flebitis químicamente inducida.(AU)

Aims: To identify commonly used intravenous drugs that may produce endothelial damage. Methods: An experimental research study was performed using a sample of 62 intravenous drugs commonly used in emergency care, pH and osmolarity were measured. Subsequently, based on these values, the theoretical capacity to cause irritation or endovascular damage was determined and classified as high, moderate, and low. Results: Samples from 19 drugs for fluid therapy, 21 antibiotics and 22 drugs for intravenous use were studied. Glucose solutions, sodium bicarbonate 1M and mannitol 10% showed a high capacity to cause venous irritation. Vancomycin, ciprofloxacin, amiodarone, haloperidol, and labetalol solution presented a high capacity for irritation based on their acidic pH. The antibiotics, dexketoprofen, diazepam, digoxin, etomidate, phenytoin, levetiracetam and metamizole also showed high osmotic values in their reconstituted or undiluted presentations. Moreover, osmolarity of diazepam, digoxin and phenytoin remained high despite being diluted in 100mL of saline. Conclusions: Knowing the pH and osmolarity of intravenous drugs allows their capacity to cause endothelial damage to be assessed. The use of comprehensive tables based on the chemical properties of the drugs can be a useful tool to help prevent chemically-induced phlebitis.(AU)

Morphine 6 glucuronide stimulates nitric oxide release in mussel neural tissues: evidence for a morphine 6 glucuronide opiate receptor subtype.

We have previously demonstrated that Mytilus edulis pedal ganglia contain opiate alkaloids, i.e., morphine and morphine 6 glucuronide (M6G), as well as mu opiate receptor subtype fragments exhibiting high sequence similarity to those found in mammals. Now we demonstrate that M6G stimulates pedal ganglia constitutive nitric oxide (NO) synthase (cNOS)-derived NO release at identical concentrations and to similar peak levels as morphine. However, the classic opiate antagonist, naloxone, only blocked the ability of morphine to stimulate cNOS-derived NO release and not that of M6G. CTOP, a mu-specific antagonist, blocked the ability of M6G to induce cNOS-derived NO release as well as that of morphine, suggesting that a novel mu opiate receptor was present and selective toward M6G. In examining a receptor displacement analysis, both opiate alkaloids displaced [3H]-dihydromorphine binding to the mu opiate receptor subtype. However, morphine exhibited a twofold higher affinity, again suggesting that a novel mu opiate receptor may be present.

Augmentation of cytotoxicity by natural killer (NK) cells after adrenaline administration in man.

After administration of 0.2 mg adrenaline subcutaneously to 8 healthy individuals, natural killer (NK) cell activity of peripheral mononuclear cells increased within 15-30 min (p less than 0.005) and returned to baseline values within two hours. The activity was correlated to plasma adrenaline concentration (r = 0.52, p less than 0.001). No changes in NK cell activity were observed in 3 control subjects receiving an injection of 0.2 ml saline.

Serum theophylline during acute asthmatic attacks.

To investigate serum theophylline levels during acute attacks of asthma, venous blood samples were taken from 41 consecutive patients. 36 had asthma and 5 suffered from chronic bronchitis. The patients were taking five different theophylline preparations. Blood samples were taken when the patients were admitted to the emergency unit because of serious deterioration in their pulmonary condition. Serum theophylline was analyzed by liquid column chromatography. 26 patients revealed subtherapeutic levels, 5 patients had levels above therapeutic range, and 10 patients had values within the therapeutic range. Thus, many patients taking oral theophylline derivatives are undertreated and a few are overmedicated.

A comparative study of zopiclone and flunitrazepam in insomniacs seen by general practitioners.

A double-blind crossover trial was conducted in 42 outpatients of either sex in order to obtain information on the properties of 7.5 mg of zopiclone in a general practice setting compared with 2 mg of flunitrazepam. Each patient went through two periods of treatment, each period lasting 10 days. A comparison of the effect of the drugs showed a significant difference with regard to effectiveness and sleep latency favoring flunitrazepam. When patient's preferences were analyzed there was a highly significant difference favoring flunitrazepam both for effectiveness and tolerance. The side effects from both drugs were generally mild.

A comparative study of zopiclone and flunitrazepam in insomniacs seen by general practitioners.

A double-blind crossover trial was conducted in 42 outpatients of either sex in order to obtain information on the properties of 7.5 mg of zopiclone in a general practice setting compared with 2 mg of flunitrazepam. Each patient went through two periods of treatment, each period lasting 10 days. A comparison of the effect of the drugs showed a significant difference with regard to effectiveness and sleep latency favoring flunitrazepam. When patient's preferences were analyzed there was a highly significant difference favoring flunitrazepam both for effectiveness and tolerance. The side effects from both drugs were generally mild.