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81. Peripartum Analgesia and Anesthesia for the Breastfeeding Mother

medications may be needed to treat side effects of opioids. Antinausea medications are considered safe, with ondansetron and other 5HT-3 blockers, dexamethasone, and metoclopramide preferred over more sedating medications, although prochlorperazine and promethazine are likely to be safe as well 48,49 (III- IV). Stool softeners and laxatives, such as docusate, senna, and bisacadoyl, are minimally absorbed from the gastrointestinal tract and are also considered safe for breastfeeding mothers 49 (III-IV

2019 Academy of Breastfeeding Medicine

82. Hydroxyzine

pruritus were randomly divided into 3 groups. The first group was treated with Avena sativa lotion, twice a day, for as long as 2 weeks; the second group received diluted vinegar; and the third group took hydroxyzine tablets 2015 16. Chloral Hydrate, Chloral Hydrate - Promethazine and Chloral Hydrate - Hydroxyzine Efficacy in Electroencephalography Sedation. 24445981 2014 05 28 2015 09 21 2014 05 28 0973-7693 81 6 2014 Jun Indian journal of pediatrics Indian J Pediatr Chloral hydrate, chloral hydrate (...) --promethazine and chloral hydrate - hydroxyzine efficacy in electroencephalography sedation. 541-6 10.1007/s12098-013-1298-y To compare efficacy and safety of chloral hydrate (CH), chloral hydrate and promethazine (CH + P (...) ) and chloral hydrate and hydroxyzine (CH + H) in electroencephalography (EEG) sedation. In a parallel single-blinded randomized clinical trial, ninety 1-7 y-old uncooperative kids who were referred to Pediatric Neurology Clinic of Shahid Sadoughi University, Yazd, Iran from April

2018 Trip Latest and Greatest

83. Pregnant women and poor sleep: medication is rarely the right solution

and third trimesters, provided that it is in the form of low-concentration aqueous or hydroalcoholic extract. In general, it is preferable to avoid taking concentrated plant extracts repeatedly for medicinal purposes during pregnancy, due to uncertainties about their effects. Some drugs with an adverse harm-benefit balance for pregnant women or the unborn child should be ruled out. These include alimemazine and promethazine; fast-acting benzodiazepines such as flunitrazepam and triazolam; melatonin

2018 Prescrire

84. Doxylamine succinate and pyridoxine hydrochloride (Xonvea) for the treatment of nausea and vomiting of pregnancy in women who do not respond to conservative management

include cyclizine, prochlorperazine, promethazine and or chlorpromazine. Clinicians should use antiemetics with which they are familiar and should use drugs from different classes if the first drug is not effective. Combinations of different drugs should be used in women who do not respond to a single antiemetic. For women with persistent or severe HG, the parenteral or rectal route may be necessary and more effective than an oral regimen. Due to the risk of extrapyramidal effects, metoclopramide (...) will resolve spontaneously within 16 to 20 weeks. 17 Additional information: comparators Cyclizine, prochlorperazine, promethazine or chlorpromazine. 12 Cost of relevant comparators Medicine Dose Regimen Cost per two week course (£) Doxylamine succinate and pyridoxine hydrochloride Initially two tablets orally at bedtime, if symptoms are not controlled this can be increased to one tablet in the morning and two tablets at bedtime and then further increased to one tablet in the morning, one tablet mid

2019 Scottish Medicines Consortium

85. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures

to residual prolonged drug effects may lead to airway obstruction. , , In particular, promethazine (Phenergan; Wyeth Pharmaceuticals, Philadelphia, PA) has a “black box warning” regarding fatal respiratory depression in children younger than 2 years. Although the liquid formulation of chloral hydrate is no longer commercially available, some hospital pharmacies now are compounding their own formulations. Low-dose chloral hydrate (10–25 mg/kg), in combination with other sedating medications, is used

2019 American Academy of Pediatrics

86. Benzodiazepines for psychosis-induced aggression or agitation. (PubMed)

benzodiazepines compared with olanzapine (n = 150, 1 RCT, RR 1.84, 95% CI 1.06 to 3.18, very low quality evidence). People receiving benzodiazepines were less likely to experience extrapyramidal effects in the medium term compared to people receiving haloperidol (n = 233, 6 RCTs, RR 0.13, 95% CI 0.04 to 0.41, low quality evidence).Benzodiazepines versus combined antipsychotics/antihistaminesWhen benzodiazepine was compared with combined antipsychotics/antihistamines (haloperidol plus promethazine

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2017 Cochrane

87. Chloral hydrate as a sedating agent for neurodiagnostic procedures in children. (PubMed)

, and three of the 13 studies had high risk of bias for selective reporting. Evaluation of the efficacy of the sedative agents was also underpowered, with all the comparisons performed in single small studies.Children who received oral chloral hydrate had lower sedation failure when compared with oral promethazine (RR 0.11, 95% CI 0.01 to 0.82; 1 study, moderate-quality evidence). Children who received oral chloral hydrate had a higher risk of sedation failure after one dose compared to those who received (...) between oral chloral hydrate, oral dexmedetomidine, oral hydroxyzine hydrochloride, and oral midazolam.Children who received oral chloral hydrate had a shorter time to achieve adequate sedation when compared with those who received oral dexmedetomidine (MD -3.86, 95% CI -5.12 to -2.6; 1 study, moderate-quality evidence), oral hydroxyzine hydrochloride (MD -7.5, 95% CI -7.85 to -7.15; 1 study, moderate-quality evidence), oral promethazine (MD -12.11, 95% CI -18.48 to -5.74; 1 study, moderate-quality

2017 Cochrane

88. Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation). (PubMed)

haloperidol with lorazepam with no significant differences with regard to number of participants asleep at one hour (1 RCT, n=60, RR 1.05, 95%CI 0.76 to 1.44, very low-quality of evidence) or those requiring additional injections (1 RCT, n=66, RR 1.14, 95%CI 0.91 to 1.43, very low-quality of evidence).Haloperidol's adverse effects were not offset by addition of lorazepam (e.g. dystonia 1 RCT, n=67, RR 8.25, 95%CI 0.46 to 147.45, very low-quality of evidence).Addition of promethazine was investigated (...) haloperidol could be life-saving. Where additional drugs are available, sole use of haloperidol for extreme emergency could be considered unethical. Addition of the sedating promethazine has support from better-grade evidence from within randomised trials. Use of an alternative antipsychotic drug is only partially supported by fragmented and poor-grade evidence. Adding a benzodiazepine to haloperidol does not have strong evidence of benefit and carries risk of additional harm.After six decades of use

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2017 Cochrane

90. CRACKCast E182 – Drug Therapy in the Geriatric Patient

guideline published semi-regularly that provides clinicians with lists of medications that should be avoided in older adults. Please refer to Table 185.3 from Rosen’s 9 th Edition for a more comprehensive summary of the most common Beers List medications prescribed in the ED. Promethazine Diphenydramine Diazepam Hydroxyzine Amitriptyline [4] List 9 harmful drug interactions in the elderly Please refer to Table 185.2 from Rosen’s 9 th Edition for a more comprehensive summary of harmful drug interactions

2018 CandiEM

92. CRACKCast E161 – Antipsychotics

is imperative and may help you save lives in the future. Shownotes – Rosen’s In Perspective A brief history of antipsychotics: In 1950, promethazine was synthesized. Soon after, chlorpromazine was synthesized. These drugs brought about sedation and apathy in patients (i.e.neuroleptic effects) The term neuroleptic has since been replaced with antipsychotic, because newer agents are less sedating In 1956, clozapine was synthesized Significant extrapyramidal effects at therapeutic doses were found to be one (...) , perphenazine, promethazine, thiordazine High Potency (First Generation Antipsychotics) Droperidol, haloperidol, loxapine, pimozide, thiothixene, trifluoperazine Atypical Antipsychotics (Second Generation Antipsychotics) Aripiprazole, asenapine, clozapine, iloperidone, lutasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone [4] Describe 4 common extrapyramidal reactions in antipsychotic use other than NMS Dystonic Reaction Oculogyric crisis (eyes rolling back in head) Opisthotonos (severe

2018 CandiEM

93. CRACKCast E177 – Acute Complications of Pregnancy

conclusion – Uptodate. Citing PMID (dopamine antagonist) Metoclopramide, promethazine, prochloroperazine (antihistamine H1 antagonists) Dimenhydrinate, meclizine or diphenhydramine [better safety profile for mother and unborn that most other drugs] Glucocorticoids Bottom line = no drug is 100% safe; no one drug is the best; each has its own safety and side effect profile, but they are all widely used and supported 21) Describe the diagnosis and management of PE and DVT in pregnancy Both are tough

2018 CandiEM

95. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. (PubMed)

of breathlessness (the primary outcome) in people with advanced cancer and COPD (8 studies, 214 participants) compared to placebo, midazolam, morphine, or promethazine. Furthermore, we observed no statistically significant effect in the prevention of episodic breathlessness (breakthrough dyspnoea) in people with cancer (after 48 hours: risk ratio of 0.76 (95% CI 0.53 to 1.09; 2 studies, 108 participants)) compared to morphine. Sensitivity analyses demonstrated no statistically significant differences regarding

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2016 Cochrane

96. Interventions for treating hyperemesis gravidarum. (PubMed)

, respectively, very low-quality evidence). However, more women taking metoclopramide complained of drowsiness and dry mouth (RR 2.40, 95% CI 1.23 to 4.69, and RR 2.38, 95% CI 1.10 to 5.11, respectively; moderate-quality evidence). There were no clear differences between groups for other side effects.In a single study with 146 participants comparing metoclopramide with promethazine, more women taking promethazine reported drowsiness, dizziness, and dystonia (RR 0.70, 95% CI 0.56 to 0.87, RR 0.48, 95% CI 0.34 (...) to 0.69, and RR 0.31, 95% CI 0.11 to 0.90, respectively, moderate-quality evidence). There were no clear differences between groups for other important outcomes including quality of life and other side effects.In a single trial with 30 women, those receiving ondansetron had no difference in duration of hospital admission compared to those receiving promethazine (MD 0.00, 95% CI -1.39 to 1.39, very low-quality evidence), although there was increased sedation with promethazine (RR 0.06, 95% CI 0.00

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2016 Cochrane

97. Analgesia and Anesthesia for the Breastfeeding Mother

. Of the anticholinergic agents, atropine is found in trace amountsinbreastmilk.Glycopyrrolateisnotexpected tobefoundinbreastmilkandispoorlyabsorbedthrough the gastrointestinal tract. 5 Antiemetics are used commonly in the perioperative period, and most of these medications are considered safe during breastfeeding. Ondansetron, dexamethasone, and metoclopramide may be preferred because of their lack of sedating side effects. 3 (IV) Prochlorperazine, promethazine, and scopolamine are likely safe, but may lead (...) to maternal sedation; promethazine and scopol- amine may also adversely affect milk supply if given repeatedly. 30–32 (III) Analgesics Opioid analgesics. Opioids are frequently used during surgery as part of a balanced anesthetic technique, and they may be continued postoperatively for pain. All opioids transferintobreastmilkinvaryingamounts,anddifferences in breast milk concentration along with variation in oral availability make certaintypes ofthesemedications moreor less safe for a breastfeeding mother

2017 Academy of Breastfeeding Medicine

98. No clear “best” treatment of mild or severe sickness in pregnancy

recurrence reduces risk of moderate/severe NVP compared with taking Diclectin once symptoms begin. Promethazine is as, and ondansetron is more, effective than metoclopramide for severe NVP/HG. I.v. fluids help correct dehydration and improve symptoms. Dextrose saline may be more effective at reducing nausea than normal saline. Transdermal clonidine patches may be effective for severe HG. Enteral feeding is effective but extreme method treatment for very severe symptoms. Day case management for moderate

2019 NIHR Dissemination Centre

99. CRACKCast E099 – Urological Disorders

; prepubescent—supportive only [6] What are the causes of different urine colour pigmentation? Straight from Life in the fast lane Green Drugs: Cimetidine, Promethazine, Amitriptyline, Flutamide, Indomethacin, Methocarbamol, Methylene blue, Mitoxantrone, Propofol, Phenylbutazone, Triamterene Condition: Hartnup Disease, Indicanemia, Indicanuria Infection: Pseudomonas Infection Dyes: Carbolic Acid, Flavine derivatives, Indigo Blue, Methylene Blue, Resorcinol Other: Clorets, Listerine, Magnesium Salicylate

2017 CandiEM

100. For Adults With Nausea and Vomiting in the Emergency Department, What Medications Provide Rapid Relief?

Difference in 30-Minute VAS (95% CI) Metoclopramide 3 (301) –5.3 (–11.3 to 0.8) Ondansetron 2 (250) –4.3 (–11.2 to 2.6) Prochlorperazine 1 (50) –1.8 (–14.4 to 10.8) Promethazine 1 (82) –8.5 (–19.8 to 2.9) Droperidol 1 (48) –15.8 (–27.0 to –4.6) VAS, 100-Point visual analog scale for nausea; CI, con?dence interval. METHODS DATA SOURCES The authors of the review searched the Cochrane Central Register of Controlled Trials (2014, issue 8), MEDLINE (January 1966 to August 2014), EMBASE (January 1980 to August (...) it virtually un- availableintheUnitedStates. Phenothiazines have been used for decades as antiemetics, yet despite their widespread use, there are several safety con- cerns. Administration of prochlor- perazine or promethazine by intravenous push has the potential to cause limb-threatening tissue necrosis. 4 It is therefore recom- mended that these medications be administered intramuscularly or as alow-doseinfusion,whichmaybe less desirable in ED settings. In addition, phenothiazines, as well

2016 Annals of Emergency Medicine Systematic Review Snapshots

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