Premedication

Opioids. Morphine [57-27-2] C yH NO, (8) the most prevalent and analgesicaHy potent of the naturally occurring opium alkaloids (qv), has been used as an anesthetic premedication for over one hundred years (93). It has also been used as an iv analgesic for the last four decades, and, since 1969, in high doses as an anesthetic agent (117). 

Insomnia is a related psychiatric illness having potentially serious consequences. In any given year up to one-third of the general population may experience insomnia and consequently considerable impact on quaUty of life. Potentially serious psychosocial, health, and socioeconomic consequences may foUow. Many sedative—hypnotics additionally have a firmly estabUshed position within the field of anesthesiology as premedication, inducing agents, and/or for maintenance in intensive care medicine. 

In rare cases, initiation of specific immunotherapy with insect venom leads to recurrent anaphylaxis, even with antihistamine premedication. In those cases, comedication with omalizumab (anti-IgE) has been reported to induce tolerance. In a case of recurrent anaphylaxis to induction of specific immunotherapy, the injection of 300 mg of omalizumab between 4 days and 1 h reportedly led to tolerance [42]. This approach also appears worthy of consideration in patients with both idiopathic recurrent anaphylaxis and mastocytosis who do not respond to standard antimediator therapy, as has been described in 2 atopic patients with ISM [43]. Most patients with mastocytosis and idiopathic anaphylaxis, however, are sufficiently controlled by standard antimediator therapy with antihistamines with or without low-dose corticosteroids. 

Freed KS. Leder RA. Alexander C. et al Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication. AJR Am J Roentgenol 2001 176 1389-1392. 

Nielsen L. Johnsen CR, Mosbech H, Poulsen LK. Mailing HJ Antihistamine premedication in specific cluster immunotherapy a double-blind, placebo-controlled study J Allergy Clin Immunol 1996 97 1207-1213. 

Most patients treated with either interferon or pegylated interferon experience flulike symptoms (fevers, chills, rigors, and myalgias). These symptoms may be mild to moderate in severity and usually occur with the first injection and diminish as the treatment continues. The flulike symptoms may be minimized by premedication with acetaminophen or a nonsteroidal anti-inflammatory drug. 

Apomorphine is approved for acute off episodes in patients with advanced stages of PD. The onset of effect is within 10 to 20 minutes and the duration of effect is about 60 minutes. It requires premedication with an antiemetic because it causes nausea and vomiting. Antiemetics that block central dopamine worsen the symptoms of PD, and 5-HT3 antagonists, such as ondansetron, can aggravate PD-related hypotension. Trimethobenzamide (300 mg three times daily) should be... 

All monoclonal antibodies end in the suffix -mab. The syllable before -mab indicates the source of the monoclonal antibody (see Table 85-4). When administering an antibody for the first time, one should consider the source. The less humanized an antibody, the greater is the chance for the patient to have an allergic-type reaction to the antibody. The more humanized the antibody, the lower is the risk of a reaction. The severity of the reactions may range from fever and chills to life-threatening allergic reactions (which have resulted in death). Premedication with acetaminophen and diphenhydramine is common before the first dose of any antibody. If a severe reaction occurs, the infusion should be stopped and the patient treated with antihistamines, corticosteroids, or other supportive measures. 

Paclitaxel Peripheral neuropathy (DLT), nausea/vomiting, alopecia, hypersensitivity reactions Use caution with any elevation in AST (SGOT). Give proper dosing for liver dysfunction. Premedicate dexamethasone, diphenhydramine, and cimetidine. 

Docetaxel Neutropenia (DLT), hyperlacrimation, fluid retention, nail disorders, myelosuppression Use with caution in liver dysfunction. Do not give if biliary tract is obstructed. Premedicate dexamethasone. 

Premedicate with acetaminophen or a NSAID to lessen flulike symptoms. 

Campath) hypotension prolonged immunosuppression (resulting in infectious complications) during treatment. Premedicate with acetaminophen, diphenhydramine, with or without a steroid to alleviate infusion-related reactions. Subcutaneous dosing may lessen acute toxicity. Initially 3 mg/day as a 2-hour infusion, increase to 1 0 mg/day, then 30 mg/day as tolerated. 

Rituximab Infusion reactions fever, chills, rigors, Premedicate with acetaminophen, diphenhydramine,... 

Watch for infusion reactions with rituximab and alemtuzumab. Premedicate with acetaminophen and diphenhydramine to prevent these reactions. 

Amphotericin B deoxycholate 0.5-1 mg/kg IV daily Premedication with acetaminophen and diphenhydramine 500 mL normal saline boluses before and after. 

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