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phenylpropionate

In order to avoid intravascular injection is fundamentally necessary to carry out the test for aspiration, which when used cartridges are especially suitable injection syringes Uphenylpropionate the vario.
The injection pressure must match the sensitivity of the fabric.
In order to prevent infections (including hepatitis) must be ensured, that whenever domestic liquor from bottles or vials are always used new sterile syringes and needles. Opened cartridges can not be used again for other patients!
Do not use a damaged cartridge for injection. Maximum security against glass breakage and flawless operation is ensured by accessories such as stands for syringes (infiltration anesthesia: phenylpropionate vario; intraligamentarnaya anesthesia: Ultraject).
Eating is possible only on the sensitivity of the return.

Interaction with other drugs

Action vasoconstrictors that increase blood pressure, such as agonists, such as epinephrine, can be enhanced by tricyclic antidepressants or  inhibitors. Similar observations have been reported for concentration of norepinephrine 1: 25,000 epinephrine and 1: 80,000 as vasoconstrictors. The concentration of epinephrine in articaine.

Pregnancy and breast-feeding

For surgical interventions during pregnancy is considered sparing local anesthesia anesthesia method. Articaine passes through the placental barrier in less than other local anesthetics. Due to the very rapid fall in the level of articaine and its rapid clearance from the body it enters the mother’s milk in clinically insignificant amounts. Therefore, to interrupt breast-feeding is not required.

Effects on driving ability

Local anesthesia articaine phenylpropionate, as shown by tests, does not cause any significant deviation from the normal ability to participate in road traffic.

Method of production :

Ampoules: 2 ml of a clear colorless glass vial (type I). 10 vials are placed in a cardboard box with instructions for use. Cartridges: 1,7 ml cartridge in a transparent, colorless glass (type I). 10 cartridge in a blister made of Pphenylpropionate aluminum foil or a block of corrugated cardboard. On 10 blisters, or blocks of corrugated cardboard in the cardboard box with the instructions for use.

 

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npp side effects

It has a rapid effect (latent period – 1 to 3 minutes). The duration of anesthesia is not less than 45 min.
Because of the low content of epinephrine in the preparation npp side effects of its effect on the cardiovascular system is expressed slightly: almost no marked increase in blood pressure and increased heart rate.

Protein binding artikaina plasma is 95%. After injection into the submucosa oral half-life averages 25 minutes. The drug is minimally crosses the placental barrier, little is excreted in breast milk. Articaine excreted from the body mainly through the kidneys.

testimony

Infiltration and conduction anesthesia in dentistry (including patients with concomitant severe somatic diseases):

 

  • uncomplicated removal of one or more teeth;
  • treatment of cavities and teeth npp side effects grinding before prosthetics.Contraindications. Hypersensitivity to articaine, epinephrine, or any other component of the drug
    Since the preparation contains epinephrine, it is contraindicated in the following cases:. In paroxysmal tachycardia and other cardiac arrhythmias, as well as closed-form of glaucoma
    should not be used for anemia (including including B-12 deficiency anemia), methemoglobinemia, hypoxia.
    Can not be used in patients with bronchial asthma with hypersensitivity to sulfites.
    The efficacy and safety of the drug in children younger than 4 years of age has not been studied.

    Dosing and Administration

    In uncomplicated removal of the upper jaw teeth in the absence of inflammation is usually injected into the submucosa in the transition folds from the vestibular side ultrakain . In rare cases, it requires additional administration from 1.7 ml to 1 ml to achieve full anesthesia. From painful palatal injections in most cases can be waived. For anesthesia palatine suture sections and to create a depot palatal need about 0.1 ml per injection of anesthetic. When you delete several adjacent teeth number of injections can usually be limited.
    In the case of the removal of the premolars of the mandible in the absence of inflammation can be dispensed with mandibular anesthesia, as infiltration anesthesia provided by injection of 1.7 ml per tooth is usually sufficient. If in this way did not achieve the desired effect, it is necessary to perform an additional injection of 1-1.7 ml of the anesthetic into the submucosa in the transitional fold of the lower jaw from the vestibular side. If in this case did not reach full anesthesia is necessary to blockade the mandibular nerve.
    When surgery articainenpp side effects on the severity and duration of the intervention dosed individually. When performing a medical procedure an adult can be administered to 7 mg articaine (articaine) per 1 kg of body weight. It was noted that the patients tolerated doses up to 500 mg (corresponding to 7 cylindrical ampoules).
    Contraindicated intravenous use!
    You can not perform an injection in the inflamed area!

    Side effect

    Depending on the dosage may occur disorders of the central nervous system: dizziness until its loss, respiratory disorders to life-threatening to stop muscle tremors and twitching of muscles up to generalized seizures, nausea, vomiting. Drop in blood pressure and heart failure may also occur with the introduction of the drug. Allergic reactions may occur: in the form of swelling or inflammation at the injection site, skin redness, itching, conjunctivitis, rhinitis, swelling of the face (angioedema) with swelling of the upper and / or lower lip, swelling of the vocal cords with a feeling of a lump in the throat and difficulty swallowing, hives, difficulty in breathing up to anaphylactic shock. Headache occurs frequently. Other side effects caused by epinephrine – tachycardia, cardiac arrhythmias, increased blood pressure – at a low concentration of 1: 200,000 (0.5 mg / 100 ml) are rare.
    Occasionally Accidental intravascular injection may appear ischemia zone until tissue necrosis at the site of injection (see. as “Important information”).
    due to the content disulphite sodium in some cases, in patients with asthma may occur hypersensitivity reactions manifested as vomiting, diarrhea, rapid breathing, acute asthma attack, disorders of consciousness or shock.

    Overdose (intoxication) drug

    Treatment is symptomatic.
    At the first signs of side effects or toxicity, such as nausea, motor restlessness, dizziness during injection, it should be discontinued, the patient translate in horizontal position, clear the airway, control heart rate and blood pressure. It is recommended, even if the symptoms do not seem too severe, provide intravenous access. When respiratory disorders, depending on the severity, give oxygen, in some cases to carry out artificial respiration. Central analeptics contraindicated. Muscle twitching or generalized convulsions removed by intravenous injection of a barbiturate or a short-acting.
    Drop in blood pressure, tachycardia or bradycardia, often eliminated when transferring patients in a horizontal position. In severe circulatory disorders and shock of any origin after stopping injections shown extraordinary measures: airway (oxygen insufflation), intravenous infusion fluid (electrolyte solution), glucocorticosteroids. Additionally, you can enter the plasma expanders albumin.
    When threatened violation of circulation and increasing bradycardia injected 0.25 ml to 1 ml of epinephrine. Intravenous injection of epinephrine must be carried out slowly under the control of heart rate and blood pressure.
    A single dose npp side effects of intravenous injection of epinephrine should not exceed 0.1 mg, if necessary, further be administered epinephrine infusion  . Severe tachycardia and tachyarrhythmia can be eliminated using antiarrhythmic drugs, but do not use non-selective beta-blockers. Oxygen delivery and control of circulation needed anyway. When the increase in blood pressure in patients with hypertension, should, if necessary, to apply the peripheral vasodilators.

     

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phenyl propionate

In all cases, you must be prepared, if necessary, to provide emergency relief to the patient.

In the event of hypersensitivity reactions the introduction of a contrast agent should be discontinued immediately and, if necessary, start the appropriate therapy, preferably intravenously.Therefore, intravenous contrast agent is advisable to use a flexible catheter. That in case of emergency to be able to take emergency measures, it is necessary to have ready the appropriate drugs, endotracheal tube and a device for mechanical ventilation. Note that patients taking beta-blockers may be resistant to treatment with drugs hypersensitivity reactions having beta-agonist activity. Care should be taken when using iodine-containing contrast agents in patients receiving beta-blockers.

During the premedication is recommended to use phenyl propionate steroids.

 

  • Disorders of the thyroid gland

 

Especially carefully weigh the risk / benefit ratio should be in patients with established or suspected hyperthyroidism or goitre, as iodinated contrast agents can cause them to hyperthyroidism or thyrotoxic crisis. the need for the evaluation function should be considered thyroid to Ultravist administration and / or appoint a preventive measure thyrostatic therapy in patients with established or suspected hyperthyroidism.

 

  • Age

 

Vascular pathology and neurological disorders commonly found in elderly people, increase the risk of adverse reactions to iodinated contrast media.

 

  • the patient’s serious condition

 

The need for research should be carefully phenyl propionate evaluated in patients with severe general condition.

 

  • kidney damage

 

All patients administered with Ultravist should ensure adequate hydration before administration of the contrast agent, preferably by intravascular infusion before and after the procedure, while contrast agent will be displayed by the kidneys.

Before removing the contrast agent by the kidneys is necessary to exclude the additional strain on the kidneys in the form of nephrotoxic drugs, oral holetsistograficheskih funds, arterial blood flow restriction in the kidney, renal artery angioplasty, major surgery etc.

It is necessary to postpone the introduction of a new study of the contrast agent to the recovery of renal function to baseline.

Patients on dialysis administered contrast agents are excreted in the process of dialysis.

 

  • CNS Diseases

 

The presence of intracranial tumors or metastases, as well as epilepsy, may increase the frequency of occurrence of convulsive episodes after injection of contrast agents. Neurological complications occur more frequently during cerebral angiography or similar studies.

 

  • Alcoholism

 

Care must be taken during the study in patients with alcoholism and drug addiction in connection with the possibility of lowering the seizure threshold.

 

  • Angiography

 

One of the properties of non-ionic contrast agents is their extremely low impact on normal physiological functions. That is why non-ionic contrast agents have less anticoagulant activity in vitro, than ionic. A number of factors, in addition to the properties of the contrast agent, such as the duration of the study, the number of injections, catheter and syringe properties, the state of the disease and treatment, it can affect the development of thromboembolic complications. Therefore, during the catheterization of the vessel must take into account these factors and to focus on the implementation of angiography techniques, and wash the catheter with saline (if necessary with the addition of heparin) and minimize the timing of the procedure, to minimize the risk of thrombosis and embolism.

The use of plastic syringes in place of glass can reduce, but not eliminate the likelihood of in vitro clotting of blood.

Care should be taken in the study of patients with homocystinuria because of the risk of thrombosis and embolism.

 

  • Introduction under the lining of the brain

 

Most adverse reactions after myelography develops within a few hours after the administration of contrast agent. During this period, should be monitored for the patient’s condition. Patients with epilepsy or a history of receiving anticonvulsant therapy should continue treatment with appropriate drugs during the study with the introduction of a contrast agent under the lining of the brain.

Care should be taken in the study of patients with alcoholism and phenyl propionate drug addiction in connection with the possibility of lowering the seizure threshold.

 

  • myelography

 

The more the patient moves or straining your muscles after injection of contrast medium, the more likely it is mixed with body fluids other areas not related to the surveyed area. As a result, contrast density decreases faster than usual.

To eliminate the discomfort caused by the loss of cerebrospinal fluid, the patient should rest for about 18 hours. During this period, should ensure the possibility of adverse reactions. Patients with reduced threshold for seizure activity should be under particularly close supervision for a few hours.

Storage
in protected from light , at a temperature no higher than 30 ° C. Keep out of the reach of children.

Product form
Ultravist Injection 240 mg iodine / ml: In 10 or 50 mL vials of neutral glass , sealed with rubber stoppers phenyl propionate, rolled aluminum caps and plastic lids closed. 10 vials with the instruction on use is placed in a cardboard box.

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phenylpropanoate

Perhaps the development of serious neurological complications. It is recommended to carefully monitor the patient’s condition.

To prevent a large number of drug phenylpropanoate in the ventricles of the brain should be made as far as possible the full aspiration of contrast medium. In case of erroneous excess dose of the drug when administered under the lining of the brain, it is necessary to carefully monitor the manifestations expressed disorders of the nervous system at least during the first 12 hours. These symptoms may be the growing increase in reflexes or tonic-clonic muscle spasms, in severe cases, the involvement of the central nervous system – generalized seizures, hyperthermia, respiratory depression and stupor.

Interactions with other drugs and other forms of interaction
Biguanides (metformin) in patients taking biguanides with intravascular administration of phenylpropanoate possible accumulation of the drug biguanide and the development of lactic acidosis. To prevent this complication, you should stop taking biguanide for 48 hours before the  contrast studies and not to renew it at least for 48 hours after the administration of contrast agent. Resume taking them should be only after the restoration of renal function.

The simultaneous use of neuroleptics and antidepressants may reduce the seizure threshold, increasing the risk of reactions associated with the use of a contrast agent.

Patients taking beta-blockers may be resistant to the drugs having a beta-agonist activity, used for the treatment of hypersensitivity reactions .

Interleukin-2: the risk of long term effects in response to increases in  preliminary treatment (for several weeks) -2 interleukin patients.

 

  • Effect on diagnostic tests

 

Radioisotopes: for several weeks after administration of phenylpropanoate drug absorption is a decrease thyritropic isotopes by the thyroid gland, which reduces their effectiveness for the diagnosis and treatment of thyroid diseases.

special instructions

 

  • Proposals for diet

 

You can stick to the usual diet, but in the last 2 hours before the study should refrain from eating.

 

  • fluid intake

 

Before and after intravascular injection or Ultravist under meninges should consume adequate amounts of liquid. Of particular importance this has for patients with multiple myeloma, diabetes mellitus, polyuria, hyperuricemia, as well as to infants, small children, patients in advanced age.

 

  • Newborns (<1 month) and young children (1 month-2 years)

 

Infants (under one year) and especially newborns are characterized by sensitivity to electrolyte imbalance and haemodynamic disorders. Attention should be given a dose of the contrast agent, technical support and radiological examination of the patient.

Ultravist as a low-osmolar water-soluble contrast agent used older due to the fact that these patients have an increased risk of aspiration, intestinal obstruction and penetration of contrast agent from the intestinal lumen during routine investigations of the gastrointestinal tract in newborns, infants and children peritoneal cavity.

 

  • Fear

 

If you have a state of excitement, anxiety and pain may increase the risk of side effects or the intensity of the reactions caused by contrast medium. Such patients may have a sedative.

 

  • Warming contrast agent before use

 

The contrast medium which has been warmed to body temperature prior to administration, better tolerated and easier to enter due to the decrease in viscosity of the solution. Heated in an oven to 37 ° C is only that amount of drug that is expected to be used. In the protection from daylight heating for a longer period does not alter the chemical purity of the preparation, but more than three months should not be exceeded.

 

  • Conduct pre-test

 

Using a small amount of contrast agent is not suitable for the sensitivity of the test, as it has no prognostic value. Moreover, conducting such testing itself can phenylpropanoate lead to serious adverse reactions.

 

  • Hypersensitivity

 

Sometimes, after applying non-ionic contrast media such as Ultravist observed allergic like hypersensitivity reactions (see. Side effects), or other manifestations of idiosyncrasy on the part of the cardiovascular, respiratory system and skin. Usually these reactions, the severity of which may be moderate to severe, including shock, occur within one hour after the administration of contrast agent.However, in rare cases can develop delayed reactions (hours to days).

Patients with known hypersensitivity to Ultravist or any of its components or to previously took place hypersensitivity reaction to any other yodsodsrzhaschemu contrast agents, there is an increased risk of hypersensitivity reactions, which require carefully weigh the benefit / risk ratio.

Patients with giperchuvstvitelnostyo or previously took place reactions to iodinated contrast media are at increased risk to develop serious reactions. However, such reactions are rare and unpredictable.

The risk of allergic reactions is increased in the following cases:

– In the presence of previously occurring reactions to iodinated contrast media
– if you have a history of asthma or other allergic diseases.

In patients with severe cardiovascular disease phenylpropanoate have an increased risk of severe or even fatal side effects.

Due to the possibility of severe hypersensitivity reactions after administration of contrast agent after the procedure is necessary to observe the condition of the patient.

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nandrolone

The doses when administered under the lining of the brain.Adults:The dosages may largely depend on the chosen clinical problem, examination technique and the region.If you nandrolone have equipment to record the image in all projections without changing the patient’s body position and the introduction of contrast medium under fluoroscopic guidance, may be sufficient smaller volume of diagnostic products.

The recommended dose for the individual studies

 

  • myelography

The amount of drug Ultravist 240 mg iodine / ml up to 12.5 ml.

Maximum dose nandrolone corresponds to a total dose of 3 g of iodine and should not be more than one study.

After examining the contrast agent should be directed to the lumbar region, which is achieved by giving the patient pryamosidyaschego position or lifting the head on the bed at 15 ° C for at least 6 hours.

Children:
Safety and efficacy of Ultravist drug during myelography not been studied

 

  • Dose when administered into the body cavity

 

During the arthrography, hysterosalpingography  administration of the contrast agent should be administered under the control of fluoroscopy.

Recommended doses for individual studies:
The dose may vary depending on the age, body weight, general condition of the patient, as well as on the chosen clinical problem, used the technical equipment and the field survey. Below are the average dose recommended to adults OK.

 

  • arthrography:

 

5-15 ml Ultravist 240 mg iodine / ml / 300 mg iodine / ml / 370 mg iodine / ml

 

  • hysterosalpingography:

 

10-25 ml of Ultravist 240 mg iodine / ml

 

 

The dosage depends on the clinical problem and solved by the size of the rendered structure.

 

  • Other cavity:

 

The dosage depends on the clinical problem and solved by the size of the rendered structure.

Side effects
Side effects in the case of the use of intravascular iodinated contrast media are usually mild, moderate and transient in nature. However, severe and life-threatening reactions, not excluding fatal reactions, did take place.

Most often, when the intravascular use of such reactions such as nausea, vomiting, pain and a burning sensation.

Headache, including the case of a long and serious form of nausea and vomiting are common. Most adverse reactions after myelography or body cavities contrast occurs within a few hours after the administration of contrast agent.

 

  • ERCP

 

In addition to the listed undesirable effects during nandrolone may increase the level of pancreatic enzymes (often), the development of pancreatitis (rare).

Overdose
In acute toxicity studies in animals have not revealed the risk of acute intoxication following use of Ultravist drug.

 

  • Intravascular administration

 

Symptoms may include an imbalance of fluids and electrolytes, kidney failure, complications of the cardiovascular system and lungs. It is necessary to control the liquid level, electrolytes, renal function.Treatment of overdose should be directed at maintaining vital functions. Ultravist can be removed from the body by the dialysis. In case of a wrong dose in excess of intravascular injection of the drug into the human body, it is necessary to compensate for the loss of water and electrolytes by infusion. It is necessary to carry out monitoring of renal function of at least 3 days.

If necessary, it can be used to derive hemodialysis main part of contrast material from the human body.

 

  • Introduction under the lining of the brain