Physostigmine for promethazine poisoning

Experience suggests that the central anticholinergic action of promethazine is a major element in the toxic effects following overdosage. Physostigmine seems to be a direct antidote at doses within the safe therapeutic range; side-effects, if they become a problem, can be treated with intravenous atropine.

Crystal structure of the charge-transfer complex promethazine picrate

Promethazine picrate (C23H23N5O7S) crystallises in the triclinic space group P[unk] with a = 8.137(1), b = 8.144(3), c = 19.224(6) Å, α = 87.78(3), β = 79.97(2), γ = 70.57(2)° and two molecules per unit cell. The structure was solved by direct methods (MULTAN 80) using 2438 observed reflections [I > 2.5 σ(I)]. Refinement was carried out by block-diagonal least-squares methods to a final R = 0.052. The picrate group is planar and is almost perpendicular to the promethazine plane. The two groups are joined by a hydrogen bond. The pairs of molecules related by a centre of symmetry make a molecular arrangement where promethazine and picrate groups are packed in sheets in three dimensions.

Separation and detection of chlorpromazine hydrochloride and promethazine hydrochloride using electrochemiluminescence followed by capillary electrophoresis

Phenothiazine drugs, chlorpromazine hydrochloride (CPZ) and promethazine hydrochloride (PMZ), were determined with Ru(bpy)(3)(2+) electrochemiluminescene by the capillary electrophoresis (CE-ECL). It was found that both CPZ and PMZ could produce an intermediate that acted as coreactants to react with Ru(bpy)(3)(2+) to produce excited states which were capable of emitting light. This CE-ECL detection method had high sensitivity, good selectivity and reproducibility for CPZ and PMZ determination.

Chiral separation of promethazine by capillary electrophoresis with end-column amperometric detection

Sensitive end-column amperometric detection has been successfully coupled to capillary electrophoresis for chiral separation of promethazine, with a carbon fiber microdisk electrode as working electrode. Baseline separation and sensitive detection were achieved under optimum conditions: 0.030 M Na2HPO4 and 0.015 M citric acid at pH = 2.50, 1.0 mM beta -CD, 10 kV separation voltage, and detection potential 1.10 V (vs Ag/AgCl). The numbers of theoretical plates were higher than 700000, and the detection limit was 5 x 10(-8) M. On-line treatment of the electrode has also been studied and discussed.

Separation of promethazine and thioridazine using capillary electrophoresis with end-column amperometric detection

Promethazine and thioridazine were separated and detected by capillary electrophoresis with end-column amperometric detection. The influence of pH Value on oxidation potential, the peak current and the resolution were studied and the following conditions was selected: 0.03 M Na2HPO4 and 0.015 M citric acid at pH 3.0, detection potential at 1.10 V. The detection limits of these two substances were in the range of 10(-8) mol/l. The linear range spanned two to three orders of magnitude. This method was applied to the detection of promethazine and thioridazine spiked in urine. (C) 1999 Elsevier Science B.V. All rights reserved.

Electroanalytical determination of promethazine hydrochloride in pharmaceutical formulations on highly boron-doped diamond electrodes using square-wave adsorptive voltammetry

The electrochemical oxidation of promethazine hydrochloride was made on highly boron-doped diamond electrodes. Cyclic voltammetry experiments showed that the oxidation mechanisms involved the formation of an adsorbed product that is more readily oxidized, producing a new peak with lower potential values whose intensity can be increased by applying the accumulation potential for given times. The parameters were optimized and the highest current intensities were obtained by applying +0.78 V for 30 seconds. The square-wave adsorptive voltammetry results obtained in BR buffer showed two well-defined peaks, dependent on the pH and on the voltammetric parameters. The best responses were obtained at pH 4.0, frequency of 50 s(-1), step of 2 mV, and amplitude of 50 mV. Under these conditions, linear responses were obtained for concentrations from 5.96 x 10(-7) to 4.76 x 10(-6) mol L-1, and calculated detection limits of 2.66 x 10(-8) mol L-1 (8.51 mu g L-1) for peak 1 and of 4.61 x 10(-8) mol L-1 (14.77 mu g L-1) for peak 2. The precision and accuracy were evaluated by repeatability and reproducibility experiments, which yielded values of less than 5.00% for both voltammetric peaks. ne applicability of this procedure was tested on commercial formulations of promethazine hydrochloride by observing the stability, specificity, recovery and precision of the procedure in complex samples. All results obtained were compared to recommended procedure by British Pharmacopeia. The voltammetric results indicate that the proposed procedure is stable and sensitive, with good reproducibility even when the accumulation steps involve short times. It is therefore very suitable for the development of the electroanalytical procedure, providing adequate sensitivity and a reliable method.

Potenciais interações medicamentosas com dano grave e sua relação com o aprazamento estabelecido por enfermeiros

Trata-se de estudo multicêntrico, com revisão retrospectiva de prontuário, que teve como objeto a associação entre o aprazamento de medicações intravenosas realizadas por enfermeiros e as potenciais interações medicamentosas (PIM) graves, encontradas em prescrições de pacientes críticos adultos hospitalizados. Os objetivos foram: a) apresentar os grupos medicamentosos e medicamentos prevalentes em cada Unidade de Tratamento Intensivo (UTI) pesquisada; b) descrever o perfil do aprazamento dos medicamentos intravenosos em cada UTI pesquisada; e, c) analisar a frequência das potenciais interações medicamentosas graves favorecidas pelo aprazamento feito por enfermeiros. Para coleta de dados foi utilizado um instrumento que contemplou o nome do medicamento, a dose, a via, a frequência de administração e os horários aprazados pelo enfermeiro, dando origem a um imenso banco de dados. Os dados foram coletados em 3 UTIs conveniadas ao SUS e pertencentes à Rede Sentinela. O levantamento das PIM foi feito de prescrição a prescrição, pareando-se todos os medicamentos intravenosos conforme critérios de inclusão, obtendo-se assim uma lista com as interações encontradas. As PIM foram identificadas nas bases Micromedex Drugs-Reax System.12 e Drugs.com. Foi encontrada uma chance quase três vezes maior (OR: 2,96) de PIM em prescrições com mais de 5 medicamentos. Às 6h foi encontrada nas UTIs A e B a maior chance de PIM. Na UTI C não foi encontrada prevalência nem OR significativa, assim como o número de doses comprometidas com PIM foi o menor entre todas as UTIs. Houve predomínio de medicamentos que atuam no sistema digestivo (31,99%), com destaque para ranitidina (44,08%). As UTI A e B seguem um mesmo padrão no que diz respeito a acumular o aprazamento, preferencialmente em quatro horários: 14h, 18h, 22h e 6h. A UTI C distribui seu aprazamento por nove horários, inclusive no horário de visitas (16h) e no início de plantão (08h e 20h). Na UTI A e B predominaram aprazamentos noturnos; na UTI C foram tarde e noite, sugerindo uma rotina organizada de acordo com o processo de trabalho de médicos, enfermagem e farmácia. Foram encontrados 47 PIM graves nos horários prevalentes. A UTI A apresentou o maior número de PIM graves (n=32). Destacam-se cinco medicamentos que, repetidamente, foram aprazados associados em PIM grave: haloperidol, metoclopramida, tramadol, furosemida e prometazina. Conclui-se que a rotina de atividades na UTI favorece o aprazamento padronizado e concentrado em poucos horários, logo a ocorrência de PIM graves, desconsiderando assim os aspectos farmacocinéticos e farmacodinâmicos dos medicamentos em uso concomitante.

A novel technique for NACE coupled with simultaneous electrochemiluminescence and electrochemical detection for fast analysis of tertiary amines

A simultaneous electrochemiluminescence (ECL) and electrochemical (EC) detection scheme for NACE was presented for fast analysis of tertiary amines. Both ECL and EC signals were generated at the same Pt electrode. Triethylamine (TEA), tripropylamine (TPrA), chlorpromazine, promethazine, and dioxopromethazine (DPZ) were selected to validate NACE-ECL/EC dual detection strategy. The linear ranges for TEA and TPrA were 0.01-500 and 0.01-10 mu M with the detection limits of 8.0 and 5.0 nM (S/N=3), respectively. The RSDs (n = 6) of the migration time and the ECL intensity for 1 mu M TEA and 0.5 mu M TPrA were 0.1 and 2.8%, and 0.2 and 1.8% with theoretical plate numbers of 180 000 and 700 000 per meter, respectively. These two analytes could be separated within 92 s and the Pt electrode did not need reactivation during the experiments.

Separation of phenothiazines in aqueous and non-aqueous capillary electrophoresis

Four phenothiazines, promethazine, dioxypromethazine, chlorpromazine, and trifluoperazine have been separated by capillary electrophoresis using N, N, -dimethylformamide (DMF) as separation medium with UV absorbance detection. High voltage and concentrated buffer were used with small current and low electroosmosis. Good resolution and high column efficiency were obtained. Separation selectivity in DMI; was different from that in water because of the different solvation interactions. The influence of buffer composition on separation selectivities and electroosmosis were also studied.

Separation of phenothiazines using aqueous and nonaqueous capillary electrophoresis

Separations of phenothiazines, promethazine(PZ), dioxypromethazine (OZ), chlorpromazine(CZ), trifluoperazine(TfZ) and thioridazine(TZ) by capillary electrophoresis in water and FA media were carried out and compared. Thus different selectivity and resolution were observed as media varying from water to FA. Migration order was PZ, OZ, CZ and TZ in water but (TZ+PZ), CZ and OZ in FA, when the same buffer, 25 mmol/L Tris and 25 mmol/L citric acid, was used. It also has been observed that pH has great effect on selectivity both in water and FA and a possible explanation was given. Separation efficiency was higher in FA media than in water because of the permission of high voltage applied. For all separations in FA 30 kV was applied, and when 25 mmol/L Tris was used as buffer, current was only 20 mu A and complete separation of TZ, CZ, PZ and OZ was achieved with effencicy higher than 3.5 x 10(5) theoretical plates for all analytes. The high performance of capillary electrophoresis in FA suggests that FA is an excellent media separation.

Estratégia anestesiológica para cesariana em paciente portadora de deficiência de fator XI: relato de caso

JUSTIFICATIVA E OBJETIVOS: A deficiência do fator XI é uma doença hematológica rara na população. A hemofilia C (deficiência do fator XI) ocorre em ambos os sexos e normalmente não apresenta qualquer sintomatologia, podendo manifestar-se apenas como hemorragia pós-cirúrgica. É uma doença autossômica recessiva, homozigótica ou heterozigótica, e sua gravidade depende dos níveis de fator XI. O objetivo desse relato foi apresentar a estratégia anestésica em paciente portadora de hemofilia C. RELATO do CASO: Paciente com 32 anos, gesta I/para 0, 39 semanas de gestação programada para cesariana eletiva. Paciente portadora de deficiência de fator XI. Exame clínico e laboratorial sem alterações. Conforme orientação do hematologista, no dia da cesárea a paciente usou prometazina 25 mg; hidrocortisona 500 mg, devido a reações transfusionais prévias, e plasma 10 mL-1.kg-1 num total de 700 mL. Após 2 horas foi submetida ao bloqueio subaracnóideo sob monitorização de rotina. Hidratação com RL 2000 mL. Procedimento anestésico-cirúrgico sem intercorrências. A paciente evoluiu no pós-operatório sem intercorrências, sendo que no 3º DPO fez uso de plasma fresco congelado (PFC) 10.mL-1.kg-1 com o objetivo de evitar sangramento pós cirúrgico tardio. CONCLUSÕES: O objetivo do caso foi apresentar o protocolo anestésico para pacientes portadores de hemofilia C e alertar para a necessidade de investigação em caso de antecedente de sangramento pós-operatório, quando um estudo da coagulação deve ser realizado antes de qualquer procedimento invasivo e, se um TTPA prolongado for encontrado, torna-se imperativo pesquisar a deficiência desse fator.