Fentanyl Benzodiazepines

LC-MS at present is only complementary to GC-MS. The LC-MS technique is applied for confirmations of positive results obtained by different immunochemical methods and for confirmation of the intake of drag(s). Nevertheless, the number of studies in which procedures for screening a single group of drugs, for example, benzodiazepines, amphetamines, fentanyl analogs (Fig. 16.1), and pesticides, or a subject... 

Drugs that may be affected by indinavir include antiarrhythmics, clarithromycin, dihydropyridine calcium channel blockers, HMG-CoA reductase inhibitors, immunosuppressant agents, phosphodiesterase type 5 inhibitors, pimozide, saquinavir, trazodone, cisapride, amiodarone, benzodiazepines, ergot alkaloids, fentanyl, rifamycins, ritonavir. 

Drugs that may affect nelfinavir include anticonvulsants, azithromycin, azole antifungals, efavirenz, delavirdine, HMG-CoA reductase inhibitors, indinavir, interleukins, nevirapine, rifabutin, rifampin, ritonavir, saquinavir, St. John s wort. Drugs that may be affected by nelfinavir include amiodarone, antiarrhythmics (amiodarone, quinidine), azithromycin, benzodiazepines, efavirenz, ergot alkaloids, delavirdine, didanosine, fentanyl, indinavir, lamivudine methadone, nonsedating antihistamines, oral contraceptives, phenytoin, pimozide, quinidine, rifabutin, saquinavir, sildenafil, sirolimus, tacrolimus, zidovudine. 

Drugs that might be affected by amprenavir include antiarrhythmics, anticonvulsants, azole antifungals, benzodiazepines, calcium channel blockers, cisapride, clarithromycin, cyclosporine, ergot alkaloids, fentanyl, HMG-CoA reductase inhibitors, indinavir, methadone, nelfinavir, oral contraceptives, pimozide, rifabutin, ritonavir, saquinavir, sildenafil, tacrolimus, trazodone, tricyclic antidepressants, warfarin, and zidovudine. 

Opioids play an important role in anesthetic practice. Opioid analgesics potentiate the efficacy of anesthetics. They can be given as part of the premedication as well as during the operation. Examples of short acting agents with high potency are fentanyl, sufentanyl, alfentanil and remifentanil. Because of their hemodynamic stability these agents can be used for patients with compromised myocardial function. Respiration must be maintained artificially and may be depressed into the postoperative period. They are usually supplemented with inhalation anesthetic, benzodiazepines or propofol. 

Opioids, such as morphine and fentanyl, are safe, whereas there is insufficient data on some other analgesics to be sure of their position. All muscle relaxants are probably safe, although there are insufficient data about most to be completely sure atropine and neostigmine are safe. Drugs which are unsafe or probably unsafe include barbiturates, etomidate, enflurane, alcuronium, mepivacaine, pentazocine, some benzodiazepines (temazepam is safe, other benzodiazepines less certain), calcium channel blockers and aminophylline. 

Serotonin syndrome SSRIs, second generation antidepressants, MAOIs, linezolid, tramadol, meperidine, fentanyl, ondansetron, sumatriptan, MDMA, LSD, St. John s wort, ginseng Hypertension, hyperreflexia, tremor, clonus, hyperthermia, hyperactive bowel sounds, diarrhea, mydriasis, agitation, coma onset within hours Sedation (benzodiazepines), paralysis, intubation and ventilation consider 5-HT2 block with cyproheptadine or chlorpromazine... 

Recovery is sufficiently rapid with most intravenous drugs to permit their use for short ambulatory (outpatient) surgical procedures. In the case of propofol, recovery times are similar to those seen with sevoflurane and desflurane. Although most intravenous anesthetics lack antinociceptive (analgesic) properties, their potency is adequate for short superficial surgical procedures when combined with nitrous oxide or local anesthetics, or both. Adjunctive use of potent opioids (eg, fentanyl, sufentanil or remifentanil see Chapter 31) contributes to improved cardiovascular stability, enhanced sedation, and perioperative analgesia. However, opioid compounds also enhance the ventilatory depressant effects of the intravenous agents and increase postoperative emesis. Benzodiazepines (eg, midazolam, diazepam) have a slower onset and slower recovery than the barbiturates or propofol and are rarely used for induction of anesthesia. However, preanesthetic administration of benzodiazepines (eg, midazolam) can be used to provide anxiolysis, sedation, and amnesia when used as part of an inhalational, intravenous, or balanced anesthetic technique. 

Adam see Ecstasy Adderall see Amphetamines Adipex-P see Diet pills Aerosol propellants see Inhalants African black see Marijuana African salad see Catha etlulis African tea see Catha etlulis Afterburner bromo see 2C-B Ah-pen-yen see Opium Air blast see Inhalants Alfenta see Fentanyl Allium sativum see Herbal drugs Alprazolam see Benzodiazepine Alurate see Barbiturates Amber see Herbal drugs Ambien see Tranquilizers American ephedra see Ephedra Amiloride see Diuretics Amitriptyline see Antidepressants Amobarbital see Barbiturates Amoeba see PCP (phencyclidine) Amoxapine see Antidepressants AMT see Dimethyltryptamine (DMT) Amy see Amyl nitrite Amyl nitrate see Amyl nitrite... 

Animal tranquilizer see PCP (phencyclidine) Antipsychotics see Tranquilizers Anxiolytics see Tranquilizers Apache see Fentanyl Aprobarbital see Barbiturates Aquachloral Supprettes see Tranquilizers Arabian tea see Catha etlulis Aroma of men see Inhalants Asendin see Antidepressants Ativan see Benzodiazepine A2 see Benzylpiperazine/Trifluoromethylphenyl-piperazine... 

Jackpot see Fentanyl Jativa-M. see Salvia divinorum Jelly baby see Amphetamines Jet see Ketamine PCP (phencyclidine) Jet fuel see PCP (phencyclidine) Jolt see GBL Joy plant see Opium Jugs see Amphetamines Juice see Alcohol Steroids Junk see Steroids Leapers see Amphetamines Legal E see BenzylpiperazinelTrifluoromethylphenyl-piperazine Legal steroid see Creatine Legal X see BenzylpiperazinelTrifluoromethylphenyl-piperazine Lemon 714 see PCP (phencyclidine) Lemon fX drops see GHB Lethal weapon see PCP (phencyclidine) Liberty caps see Psilocybin Librium see Benzodiazepine... 

Stuff see Heroin Steroids Stupefi see Rohypnol Stupefy see Benzodiazepine Sublimaze see Fentanyl Substance see BenzylpiperazinefTrifluo-romethylphenylpiperazine Sucol B see GBL... 

Several drugs are used intravenously, alone or in combination with other drugs, to achieve an anesthetic state (as components of balanced anesthesia) or to sedate patients in intensive care units who must be mechanically ventilated. These drugs include the following (1) barbiturates (thiopental, methohexital) (2) benzodiazepines (midazolam, diazepam) (3) opioid analgesics (morphine, fentanyl, sufentanil, alfentanil, remifentanil) (4) propofol (5) ketamine and (6) miscellaneous drugs (droperidol, etomidate, dexmedetomidine). Figure 25-2 shows the structures of... 

Adjunctive use of potent opioids (eg, fentanyl and related compounds) contributes cardiovascular stability, enhanced sedation, and profound analgesia. Other intravenous agents such as the benzodiazepines (eg, midazolam, diazepam) have slower onset and recovery features and are rarely used for induction of anesthesia. However, preanesthetic administration of benzodiazepines can be used to provide a basal level of sedation and amnesia when used in conjunction with other anesthetic agents. 

Fentanyl competes for hepatic oxidative pathways that metabolize most benzodiazepines, as well as zolpidem, zopiclone, and buspirone (SEDA-22, 39) (SEDA-22, 41). 

Omeprazole, like cimetidine, can impair benzodiazepine metabolism and lead to adverse effects (SEDA-18, 43). Other drugs, including antibiotics (erythromycin, chloramphenicol, isoniazid), antifungal drugs (ketoconazole, itraconazole, and analogues), some SSRIs (fluoxetine, paroxetine), other antidepressants (nefazodone), protease inhibitors (saquinavir), opioids (fentanyl), calcium channel blockers (diltiazem, verapamil), and disulfiram also compete for hepatic oxidative pathways that metabolize most benzodiazepines, as well as zolpidem, zopiclone, and buspirone (SEDA-22,39) (SEDA-22,41). 

Ketamine often causes emergence delirium and disturbing dreaming. Benzodiazepines are often co-adminis-tered to attempt to manage this. The optimal dose of diazepam to add to ketamine-fentanyl field anaesthesia has been assessed in a randomized double-blind study in 400 patients from Vanuatu the optimal dose was 0.1 mg/ kg (436). 

Clinically important, potentially hazardous interactions with amiodarone, amitriptyline, amoxapine, benzodiazepines, bepridil, clomipramine, clonazepam, clorazepate, delavirdine, desipramine, diazepam, dihydroergotamine, doxepin, ergotamine, fentanyl, flurazepam, imipramine, ixabepilone, lidocaine, lorazepam, methysergide, midazolam, nortriptyline, oxazepam, phenytoin, protriptyline, quazepam, quinidine, rifampin, ritonavir, sildenafil, St John s wort, temazepam, tricyclic antidepressants, trimipramine, vitamin E... 

Intranasal drug delivery This drug delivery provides fast and direct access to systemic circulation without first-pass metabolism. Administration is not easy especially with uncooperative children, but small volumes involved, rapidity of execution, feasibility at home has made it more attractive, particularly for no-needle approach to acute Illnesses. Aerosols with an appropriate device can avoid swallowing and is more precise in terms of dose. Drugs such as benzodiazepines, fentanyl, diamorphine, and ketamine have been used successfully via this route (90). 

Table IV-1-10 summarizes the properties of drugs of abuse. These include the CNS stimulants (cocaine j and amphetamines), the CNS depressants (benzodiazepines, barbiturates, and ethanol), the opioids j (morphine, heroin, methadone, fentanyl, and others), the hallucinogens (marijuana and other j...

Answer A. The signs and symptoms are characteristic of a CNS stimulant that facilitates the activity of amines in both the CNS and the periphery. Amphetamines promote the release of NE from sympathetic nerve endings, causing CV stimulation and pupillary dilation. In the CNS, they enhance the actions of DA, NE, and 5HT, causing behavioral excitation and a psychotic state that may be difficult to distinguish from schizophrenia. Ethanol, marijuana, fentanyl, and flunitrazepam (a benzodiazepine that has been used in date rape ) are all CNS depressants. 

In general the combined use of benzodiazepines with atfentanil or fentanyl is synei istic but may also result in additive effects on respiratory depression and/or hypotension. A pharmacokinetic study found that fentanyl reduced the metabolism of midazolam. Retrospective evidence suggests that midazolam can increase the dose requirement of sufentanil, but midazolam did not alter the analgesic efficacy of fentanyl in healthy subjects. 

Combining midazolam and alfentanil or fentanyl for the induction of anaesthesia reduces the dose required of both the benzodiazepine and the opioid, when compared with either drug alone.The interaction is synergistic. ... 

Inereased sedative and respiratory depressant effeets are to be expeeted when benzodiazepines are used with opioids. The manufaeturers of sufentanil and alfentanil suggest that elinieally important hypotension may oeeur and this may be exaeerbated by the use of benzodiazepines it would seem prudent to be alert for this. The manufaeturers of transdermal fentanyl also warn of the possibility of respiratory depression, hypotension, profound sedation and potentially coma with concurrent CNS depressants including benzodiazepines. When such combined therapy is contemplated, the dose of one or both drugs should be significantly reduced. ... 

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