Painful injections

Hot flushes, skeletal pain, injection site pain, hypertension, headache, insomnia, dizziness, vomiting, diarrhea, impotence... 

Penicillin G benzathine 1.2 million units 600,000 units (if under 27 kg) 1 IM dose Useful for nonadherence or emesis painful injection... 

Macrophage 250- or 500-mcg vial size Bone pain Injection-site skin reaction older patients with AML Limited experience and lack of FDA approval for prevention of febrile neutropenia... 

The less-frequent dosing of Neulasta means that patients will require fewer painful injections and fewer office visits. A clinical trial investigator observed, This approval... 

Drug injection is a parenteral delivery method and bypasses problems associated with the first-pass effect and absorption through the digestive system. Delivery by injection is common despite several issues fear of needles, painful injections, and potential infection... 

By December Barlow s condition had begun to decline. His temperature exceeded 103 degrees Fahrenheit, blood and mucus appeared regularly in his urine and stools. He could only sleep with the aid of sedatives. Being the consummate scientist, Barlow frequently examined his own specimens and kept an almost daily record of his clinical and laboratory observations. For example, in tests of his urine he found he was passing up to 12,000 eggs in each 24-hour sample. Barlow was a very sick man, so sick that he was subjected to extremely painful injections of antimony. Treatment with the heavy metal did clear Barlow of the infection by December 1944. In 1948 Barlow received the Medal of Merit from President Truman. He died at the ripe old age of 93. 

Finally, the fourth condition is that the pressure drops sufficiently quickly and to an extent to where the fluid cannot penetrate the muscle fascia and result in an intramuscular injection. Some individuals have a subcutaneous layer that is only a few millimeters thick and so the muscle fascia is almost certain to be impacted by the liquid jet and if the pressure of the liquid does not drop substantially in the first few milliseconds, possibly even the first millisecond in very thin people, then an intramuscular injection will result. This will consequently result in a significantly different pharmacokinetic profile and may also result in a significantly more painful injection. These conditions are summarized in Fig. 1. 

Injection-site pain Injection-site reactions (2004) Sundar S +, Clin Infect D/s 38(3), 377... 

Injection-site pain Injection-site phlebitis... 

Injection-site erythema Injection-site pain Injection-site phlebitis (< I %)... 

The development step, whose purpose is the continuation of the improvement of the pharmacokinetic properties and the fine-tuning of the pharmaceutic properties of active substances to render them suitable for clinical use. This can consist, to name a few instances, in the preparation of better-absorbed compounds, of sustained release formulations and of water-soluble derivatives or in the elimination of properties related to the patient s compliance (irritation, painful injection, undesirable organoleptic properties). For an example, see Figure 2.2. 

When an initially painful intravenous or intramuscular injection must be administered repetitively, patient reluctance develops. Injection pains are usually accompanied by hemorrhage, edema, inflammation, and tissue necrosis." Among the factors responsible for painful injections, the most important are the drug solubility in aqueous medium, the viscosity, the pH and the hypo- or hyperosmotic character of the injected drug solution, the amount of the injected volume, the site of injection, the pain tolerance of the patient, and the technique of administration. Other factors include precipitation of the drug at the injection site, and localized cell lysis. ... 

Whilst the delivery systems described so far have all been applied parentally, patients would appreciate more convenient formulations that could be taken perorally, or that at least do not require a painful injection. 

Nonionizable moieties (e.g. polyhydroxylated chains) do not present this disadvantage and are compatible with other drug preparations. As they can be delivered at pH values close to 7, they do not produce painful injections. The main problems encountered with nonionizable solubilizing moities is their lesser propensity to crystallize. In addition increased cost can be expected from the necessity of added protection/deprotection steps during their synthesis. 

Dealing with mesomorphic crystalline forms Increasing the melting point Gastrointestinal irritability and painful injections A Gastrointestinal irritability B Avoidance of painful injections Vll Suppression of undesirable organoleptic properties A Odour B Taste References... 

VI GASTROINTESTINAL IRRITABILITY AND PAINFUL INJECTIONS A Gastrointestinal irritability... 

For subcutaneous injection (when topical treatment fails to relieve pain), inject 5-10% calcium giuconate (not chloride) SC (0.5-1 mL/cm of affected skin) using a 27-gauge or smaller needle. This can be repeated two to three times at 1- to 2-hour intervals if pain is not relieved. No more than 0.5 mL should be injected into each digit. 

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