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Rectal Nitroglycerin

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1. Rectal Nitroglycerin

Rectal Nitroglycerin Rectal Nitroglycerin Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Rectal Nitroglycerin Rectal Nitroglycerin (...) Aka: Rectal Nitroglycerin , Glyceryl Trinitrate , Rectiv From Related Chapters II. Indications III. Preparations Glyceryl Trinitrate ointment 0.2% to 0.4% (Compounded by pharmacies) Nitroglcycerin ointment 0.4% (Rectiv) IV. Dosing Apply twice daily for 6 weeks V. Mechanism Chemical sphincterotomy Reduces maximal anal resting pressure VI. Adverse effects Severe (25%) Apply with glove or finger cot to prevent absorption Start at 25-50% of typical dose and advance VII. Drug Interactions s (e.g

2018 FP Notebook

2. A Multicenter, Prospective, Randomized Controlled Trial Evaluating the Efficacy of Rectal Diclofenac and Sublingual Nitroglycerin as a Combined Prophylactic Treatment for Post-ERCP Pancreatitis. (PubMed)

A Multicenter, Prospective, Randomized Controlled Trial Evaluating the Efficacy of Rectal Diclofenac and Sublingual Nitroglycerin as a Combined Prophylactic Treatment for Post-ERCP Pancreatitis. Acute pancreatitis is the major complication of endoscopic retrograde cholangiopancreatography (ERCP). A preliminary research suggested that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) with nitroglycerin might reduce the incidence of post-ERCP pancreatitis (PEP) more effectively (...) than NSAIDs alone. We conduct a two-arm, multicenter, prospective, randomized, superiority trial to evaluate the additional effect of nitroglycerin for prevention of PEP. A total of 900 patients randomly receive 50 mg diclofenac suppository either alone or with 5 mg isosorbide dinitrate sublingual tablet. The primary endpoint is the occurrence of PEP. This study will clarify whether NSAIDs plus nitroglycerin can prevent PEP.

2016 Acta medica Okayama Controlled trial quality: uncertain

3. Efficacy of egg yolk and nitroglycerin ointment as treatments for acute anal fissures: A randomized clinical trial study. (PubMed)

. For the second group, one egg yolk once a day was administered rectally up to 10 days. The pain and bleeding severity were recorded every two days up to 10 days after finishing the treatment course, based on visual scale.The results showed that egg yolk caused a significant reduction in pain and bleeding compared with nitroglycerin (p<0.05). At the beginning of the study, the difference in pain intensity between the two groups was not statistically significant (p-value = 0.25). However, it became significant (...) Efficacy of egg yolk and nitroglycerin ointment as treatments for acute anal fissures: A randomized clinical trial study. Acute anal fissure as a common disease in society has several etiologies and manifestations such as severe anal pain and bleeding. Nitroglycerin ointment 0.2% is the most common topical treatment used. The most common side effect of nitroglycerin is headache, which is annoying for patients and often leads to discontinuation of the drug.Comparison of egg yolk as a natural

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2016 Electronic physician Controlled trial quality: uncertain

4. Rectal Nitroglycerin

Rectal Nitroglycerin Rectal Nitroglycerin Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Rectal Nitroglycerin Rectal Nitroglycerin (...) Aka: Rectal Nitroglycerin , Glyceryl Trinitrate , Rectiv From Related Chapters II. Indications III. Preparations Glyceryl Trinitrate ointment 0.2% to 0.4% (Compounded by pharmacies) Nitroglcycerin ointment 0.4% (Rectiv) IV. Dosing Apply twice daily for 6 weeks V. Mechanism Chemical sphincterotomy Reduces maximal anal resting pressure VI. Adverse effects Severe (25%) Apply with glove or finger cot to prevent absorption Start at 25-50% of typical dose and advance VII. Drug Interactions s (e.g

2015 FP Notebook

5. Dose Escalation Trial of Nitroglycerin, 5-flourouracil and Rad Therapy for Rectal Cancer

Dose Escalation Trial of Nitroglycerin, 5-flourouracil and Rad Therapy for Rectal Cancer Dose Escalation Trial of Nitroglycerin, 5-flourouracil and Rad Therapy for Rectal Cancer - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies (...) before adding more. Dose Escalation Trial of Nitroglycerin, 5-flourouracil and Rad Therapy for Rectal Cancer The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT01407107 Recruitment Status : Unknown Verified May 2016 by University of Texas Southwestern Medical Center. Recruitment status was: Active

2011 Clinical Trials

6. Comparison of the efficacy and safety of topical diltiazem and nitroglycerine for pain relief during transrectal ultrasound guided biopsy of the prostate. (PubMed)

Comparison of the efficacy and safety of topical diltiazem and nitroglycerine for pain relief during transrectal ultrasound guided biopsy of the prostate. Transrectal ultrasound biopsy of prostate is a painful procedure. The introduction of the rectal probe is one of the major contributors to the pain associated with this procedure. Drugs that relax the anal sphincter should theoretically decrease this pain. This study was done to compare the efficacy and safety of two topical medications (...) that relax the anal sphincter, diltiazem and nitroglycerine, in decreasing the pain associated with transrectal ultrasound guided prostate biopsy.66 patients who were to undergo their first prostate biopsy were randomized to receive either 2 mL of 2 % topical diltiazem or 2 mL of 0.2 % topical nitroglycerine or placebo 20 minutes before prostate biopsy. All patients also received 15 mL of intrarectal lignocaine. A 10-point visual analogue score was used to record the pain immediately after the insertion

2012 International braz j urol : official journal of the Brazilian Society of Urology Controlled trial quality: uncertain

9. CRACKCast E154 – Cocaine and Other Sympathomimetics

delirium. [5] Describe the management goals and pharmacologic interventions for severe cocaine intoxication Please refer to Box 149.3 in Rosen’s 9 th Edition for a comprehensive table outlining the initial evaluation of patients with sympathetic stimulation. Priorities: SAFETY – patient and staff Chemical sedation IM benzo’s (e.g. Midazolam 0.2 mg/kg IM = usually 10 mg) Assessment Glucose, FULL set of vital signs GET A CORE TEMPERATURE (rectal) Full physical examination IV access and oxygenation via (...) NRB (doubles as a spit mask) Chemical sedation Benzo’s** – Diazepam can be administered intravenously in increments of 5 to 10 mg every 5 minutes in adults until sedation is achieved. PRN Haldol IM 2.5-5 mg [see note] Investigations EKG Urinalysis Serum CK Cooling AGGRESSIVELY cool if temp > 41°C (rectal temp) IV fluids – repletion of salt and water depletion Consider need for paralysis and intubation NOTE: Antipsychotic agents such as haloperidol are rapidly effective and generally safe for drug

2018 CandiEM

10. Erectile Dysfunction

assessment of the scrotal skin and palpation of the testicles to assess for size, consistency, and location. Digital rectal examination (DRE) is not required for evaluation of ED; however, BPH is a common comorbid condition in men with ED and may merit evaluation and treatment. Because BPH/LUTS are commonly comorbid and detected at the same time as ED, appropriate evaluation and therapy for these conditions should be considered. For a detailed discussion of BPH/LUTS, please see the AUA Guideline

2018 American Urological Association

11. CRACKCast E171 – Pediatric Cardiac Disorders

for the 2 bigs and 2 fasts as well as wheezes or cough) If decompensated cardiogenic shock: 1st line pressor: norepinephrine 2nd line inotrope: dobutamine or epinephrine NOTE: What is absent? Don’t give venodilators like nitroglycerin as first line agents! Children are much more sensitive to the drug’s potent vasodilatory effects than adults, and they can experience profound and rapid hypotension with its administration. Amrinone and milrinone, most commonly used in the ICU setting, [8] List 12 (...) ) ● HR < 180 (children) ● Variable beat-to-beat ● HR changes with activity Mgmt ● See next question! Treat the underlying cause Trial of analgesia, fluids and antiemetics [10] Describe the management of SVT in the infant/child. Unstable (poor perfusion, AMS, long cap refill, pallor, cyanosis, hypotension) CARDIOVERSION! 5 – 1 J/kg; if no success then increase to 2 J/kg Stable Vagal attempts Vagal maneuvers (eg, a bag containing a slurry of crushed ice and water to the face, digital rectal exam

2018 CandiEM

12. Clinical Practice Guidelines for the Management of Hemorrhoids

Clinical Practice Guidelines for the Management of Hemorrhoids Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited. 284 DISEASES OF THE COLON & RECTUM VOLUME 61: 3 (2018) T he American Society of Colon and Rectal Surgeons (ASCRS) is dedicated to assuring high-quality pa- tient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines (...) Com- mittee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for condi- tions related to the colon, rectum, and anus. This is accom- panied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive and not prescriptive. Their purpose is to provide informa- tion on which decisions

2018 American Society of Colon and Rectal Surgeons

13. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain

after aminophylline and paradoxically to decrease enflurane-induced seizure activity. In humans, ketamine has been shown to enhance epileptic discharges, which may explain the rare occurrence of seizures. Ketamine is a versatile drug that can be administered via many routes including IV, intramuscular, insufflation/intranasal, inhalational (smoked), oral (elixir or compounded pills), topical (minimal systemic absorption), and rectal ( ). It is both water and lipid soluble, which allows for extensive

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2018 American Society of Regional Anesthesia and Pain Medicine

14. CRACKCast E180 – Labor & Delivery

% of cases) Requires a thorough, well lit exam: look in the vagine and rectal area. Look for uterine inversion, consider whether uterine rupture may have occurred. Tears and lacerations may involve the perineum, rectum, cervix, vagina, vulva, and urethra. ● Continue supportive care as above ● Repair any lacerations/tears Coagulopathy Usually is the case in women with severe hemorrhage despite investigating and treating the above causes. should be evaluated for disseminated intravascular coagulation (DIC (...) , pressure should be applied to the part of the fundus nearest the ring to ease it through from bottom to top. – Uptodate. Therefore, all uterotonic agents should be withheld immediately on diagnosis of uterine inversion. If initial attempts fail and a cervical ring develops, pharmacologic attempts to relax the uterus with Nitroglycerin (50 mcg IV boluses), sedation and tocolytics are indicated. Terbutaline and magnesium sulfate have been used successfully to relax cervical rings. When the uterus has

2018 CandiEM

16. CRACKCast E096 – Anorectal Disorders

are extremely embarrassing and have a HUGE impact on our QOL! Copied from: Describe the neurologic control of defecation. So, normal defecation is a balance between the PNS and SNS. Sympathetic fibers (L1-5) inhibit the contraction of rectal smooth muscle in the upper rectum and lower rectum and L5 fibers cause the internal sphincter to contract. Parasympathetic fibers (lower down at S2-S4) cause the rectal wall to contract, AND the internal sphincter to relax. The external sphincter – has voluntary control (...) via S2,3,4. The sensation of rectal fullness depends on intact parasympathetic fibers. Sympathetic works = squeezes things “in” Parasympathetic works to = PUSH things “out” Defecation depends on rectal distension, internal sphincter relaxation (involuntary) and stool entering the anal canal. Then at the appropriate time there is voluntary relaxation of the external anal sphincter What is the pathophysiology of haemorrhoids? Form when three “anal vascular submucosal cushions become engorged

2017 CandiEM

17. Clinical Practice Guideline for the Management of Anal Fissures

Clinical Practice Guideline for the Management of Anal Fissures Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited. 7 Diseases of the Colon & ReCtum Volume 60: 1 (2017) t he a merican s ociety of Colon and Rectal surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and manage- ment of disorders and diseases of the colon, rectum, and anus. t he Clinical Practice Guidelines (...) Committee is com- posed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. t his committee was created to lead interna- tional efforts in defining quality care for conditions related to the colon, rectum, and anus. t his is accompanied by developing clinical practice guidelines based on the best available evidence. t hese guidelines are inclusive, and not prescriptive. t heir purpose is to provide information based on which decisions

2017 American Society of Colon and Rectal Surgeons

18. Postpartum Hemorrhage

to very low due to serious risk of bias in the included trials and the imprecision of the estimates of effect. (GRADE Table 7) Should misoprostol be used to prevent PPH? Misoprostol has been proposed as an alternative strategy for prevention of PPH in settings where oxytocin or other conventional injectable uterotonics are not available. Its advantages over oxytocin include the potential for oral, sublingual or rectal administration (eliminating the need for sterile equipment) and stability at room

2016 Ontario Midwives

20. Erectile dysfunction

the degree of androgenisation. A digital rectal examination (DRE) is recommended: If there are symptoms of an enlarged prostate, including obstructive urinary symptoms (such as a weak and intermittent urinary stream). Rarely, the enlarged prostate obstructs the flow of ejaculate causing prolonged and intermittent ejaculation. In men with a history of prostate cancer. In men aged over 50 years. Arrange appropriate investigations to identify any reversible/modifiable of erectile dysfunction. In all men

2019 NICE Clinical Knowledge Summaries

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