Injection forming

Oxazepam is available in oral form only, so it is useful only for uncomplicated withdrawal. Other benzodiazepines are available in injectable form and will be further described below. Diazepam and lorazepam are more lipophilic than chlordiazepoxide and oxazepam, resulting in quicker gastrointestinal absorption and passage across the blood-brain barrier, which makes them valuable in an inpatient setting, especially to treat or prevent seizures. However, their faster onset of action maybe associated with feeling high, which can be a disadvantage of their use. 

Premature ignition can be reduced or eliminated by redesigning the fuel delivery system, which can be categorized into three types central-, port-, and direct injection. Central and port fuel injections form the fuel-air mixture during the intake stroke. In the case of central injection (or a carburetor), the injection is at the inlet of the air intake manifold. In the case of port injection, fuel is injected at the inlet port. Direct injection is technologically sophisticated and involves forming the fuel-air mixture inside the combustion cylinder after the air intake valve has closed [27-36]. 

Kagkadis, K. A., Rekkas, D. M., Dallas, P. P., Choulis, N. H. A freeze-dried injectable form of ibuprofen Development and optimization using respond surface methodology. PDA Journal of Pharmaceitical Science Technology, 50 (5), p. 317-323, 1996... 

Recently, BN 52063 has been demonstrated to be effective against mastocytosis [304], a condition which was previously incurable. This suggests that PAF, as well as mast cell degranulation, may have a role in systemic mastocytosis. The injectable (pure) form of BN 52021 is much more powerful than BN 52063. Preliminary clinical investigations have shown a long and intense inhibition of ex vivo PAF-induced platelet aggregation. The injectable form is now under clinical trials in graft rejection, stroke, haemodialysis and shock. 

In 1970, the U.S. government passed the original Controlled Substances Act, and under this law methamphetamine was classified as a Schedule II drug in its injectable form and a Schedule III in its noninjectable (pill) form. However, a year later, both forms of methamphetamine were reclassified as Schedule II drugs. Today, it is still sold under the name Des-oxyn for a few medical uses, such as for the treatment of atten-tion-deficit/hyperactivity disorder (ADHD) and narcolepsy. 

An injectable form of ginkgo extract was removed from the market due to adverse effects, and use of ginkgo seed kernels rather than leaves is more associated with toxicity. 

When an antipsychotic is needed, we prefer using one of the newer atypical agents olanzapine, ziprasidone, risperidone, quetiapine, or aripiprazole. Each of these medications reliably reduces agitation and is well tolerated. In particular, they decrease the potential for acute dystonic reactions and tardive dyskinesia caused by the typical antipsychotics. Both ziprasidone and olanzapine are now available in an injectable form that is very rapidly acting and effective in this setting. 

It is available in both oral and injectable forms and has a calming effect on agitated patients. Chlorpromazine should typically be started at doses no higher than lOOmg/day and increased stepwise. Otherwise, dizziness due to orthostatic hypotension is quite a problem. 

Thiothixene (Navane). Thiothixene is sometimes grouped with the medium potency and at other times with the high potency antipsychotics. Its potency is actually about halfway between these two groups. Thiothixene is available in both oral and injectable forms. It should be initiated at doses of about 5mg/day and can be... 

Trifluoperazine (Stelazine). Trifluoperazine is very similar to thiothixene. It comes in both oral and injectable forms. Its dose range is the same as thiothixene. 

Pimozide (Orap). Pimozide is probably the most potent of all antipsychotics, but it is seldom used to treat schizophrenia. Instead, pimozide is most often used to treat Tourette s syndrome. There is actually no reason why pimozide can t be used to treat psychosis and no reason why other antipsychotics are not effective in Tourette s syndrome. Pimozide was simply used first in controlled clinical trials to treat Tourette s syndrome, and the physicians who routinely treat that illness became accustomed to using it. Pimozide is only available in an oral form. The lack of an injectable form to treat agitated patients as well as the lack of availability of data from controlled trials in schizophrenia patients likely explains why it has not been used very often in the treatment of schizophrenia. 

An intramuscular injection form of olanzapine, administered at doses from 2.5 to 10 mg, is now available for the management of acute agitation in the inpatient setting. This injectable olanzapine has no role in outpatient care however, a depot formulation of olanzapine is expected in the near future. 

Delusions/Psychosis. Demented patients who are acutely psychotic and agitated should be treated in much the same manner as demented patients with delirium. Low doses of a high potency conventional antipsychotic like haloperidol were once preferred. This was mainly because it can be given both orally and by injection. In recent years, the atypical antipsychotic ziprasidone, which is now also available in oral and injectable forms, has superseded haloperidol as the preferred agent when treating the acutely psychotic and agitated patient with dementia. As previously noted, ziprasidone affords the same tranquilizing benefit as haloperidol, it can now be administered via injection when necessary, and it avoids the problematic extrapyramidal symptoms of haloperidol to which patients with dementia are often keenly sensitive. 

Anxiety. Like psychosis, choosing a medication to treat anxiety in demented patients depends in large part on whether the anxiety is acute or longstanding. Acute severe anxiety requires rapid relief. For this, we recommend a benzodiazepine. Our first choice is lorazepam (Ativan) that is given as needed at 0.25-0.5 mg per dose. We prefer lorazepam because elderly patients tolerate it well (i.e., they metabolize it easily), and it is available in both oral and injectable forms. Oxazepam (Serax) is another benzodiazepine that older patients metabolize easily, but it is only available in oral form. When using benzodiazepines, be careful that your patients do not become overly sedated or delirious. 

Brief Severe Agitation. Acute management of severe agitation with physical aggression requires more definitive treatment. The first choice is haloperidol given in low doses (0.25-1 mg) as needed. Lorazepam can also be helpful if used briefly. Risperidone, olanzapine, quetiapine, or trazodone can also be used but are not available in injectable forms. 

The so-called atypical antipsychotics represent one of the newest options for managing disruptive behavioral syndromes. Because they have yet to be studied in patients who have suffered a TBI, we certainly cannot recommend the atypical antipsychotics for routine first-line use. Nevertheless, an atypical antipsychotic might prove helpful when other medicines aren t providing satisfactory results in the management of severe behavioral disturbances. Ziprasidone (Geodon) is available in an injectable form that we have found to be particularly helpful in TBI patients. 

Another anti-cocaine drug is under development by DrugAbuse Sciences, Inc., a California company whose business plan is built solely upon developing pharmacotherapy drugs. DrugAbuse Sciences is racing to develop DAS-431, a cocaine vaccine that the company aims to release in both an injectable form as well as an inhalable aerosol. ... 

WAP-8294A2 (JA-002) (157) Antibiotic WAP-8294A2(157) Antibacterial (MRSA infections and acne) Interacts selectively to membrane phospholipids, causing sever damage to bacterial membrane Various Phase I/II trials (gel, cream, injectable form) aRigen Pharmaceuticals 821-824... 

Initial use of injectable forms of diltiazem should be, if possible, in a setting where monitoring and resuscitation capabilities, including DC cardioversion/defibrillation, are present. Once familiarity of the patient s response is established, use in an office setting may be acceptable. 

Parenteral Use lower doses (2 to 5 mg) and slow dosage increases for elderly or debilitated patients and when other sedatives are given. When acute symptoms are controlled with the injectable form, administer oral therapy if further treatment is required. 

All of these compounds are well absorbed after oral administration, leaving injectable forms with few legitimate applications. Although several catabolic pathways metabolize the amphetamines, a considerable portion... 

C. Midazolam, like all benzodiazepines given in sufficient dose, has the capacity to produce anterograde amnesia. It is also available in an injectable form and frequently is used as an anesthetic agent during short procedures. 

Androgens come in oral, injectable, implantable, and topical preparations. Because of the toxicity of the oral preparations and the inconvenience of the injectable forms, the transdermal gels have been a major clinical advance for treatment of hypogonadal males. 

Olanzapine is also available in a short-acting intramuscular injectable form, providing clinicians with another option for treating... 

Cyclizine has antimuscarinic properties and is a potent anti-emetic, effective for the control of postoperative and drug-induced nausea and vomiting. It has been used to prevent motion sickness, although diphenhydramine and promethazine are more effective. It is available in oral and parenteral formulations. In contrast to many other first-generation antihistamines sedation is not marked. It is available in tablet form as the hydrochloride and in injectable form as the lactate. Because of its anticholinergic action, blurred vision and dry mouth are associated with clinical doses. When given by rapid intravenous injection tachycardia may be a problem. Meclozine is a related drug which, like cyclizine, is used primarily for motion sickness. 

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