Question

In this course project, you will be creating Pharmacology Information Cards for the most common medications related to surgery. For detailed instructions, review the Requirements section of the Course Project Introduction page in Module 01. Instructions For Information Cards Part 2, create an information card for each of the following medications (8 total):

1.Methylene blue

2.Gentian violet

3.Acetic acid

4.Mannitol

5.Oxytocin

6.Prednisone

7.Epinephrine

8.Norepinephrine

Each Pharmacology Information Card should focus on a single medication used in the surgical environment and must contain the following information:

a.Generic name/Brand name(s)

b.Indications and usage

c.Classification schedule

d.Dosage forms

e.Adverse reactions/side effects

f.APA formatted credible source(s)

Answer 1

Methylene blue

a. Generic name – METHYLENE BLUE SYSTEMIC

   Brand name(s) - Provayblue, Urolene blue

b.Indications and usage

1) Methylene blue (1%) IV is used over 30 min in ICU 1hour before surgery to decrease the incidence and severity of Vasoplegic syndrome (arterial pressure <50 mm Hg, cardiac index >2.5 L /min/m² , right atrial pressure <5 mm Hg, left atrial pressure <10 mm Hg and low systemic vascular resistance <800 dyne/sec/cm)in high risk patients (preoperative use of heparin, ACE inhibitors, congestive heart failure, poor left ventricular function, duration of cardiopulmonary bypass , re-operation, and opiod anesthesia).

2) It is also used to treat severe vasoplegia in post operative transplant patient to decrease the mortality in vasoplegic patients after cardiac surgery.

3) Methylene blue is a potent inhibitor of guanylate cyclase and hence been used to improve the arterial pressure and cardiac function in septic shock.

4) Methylene blue infusion is used as a safe and effective method of

o localizing abnormal parathyroid glands.

o intraoperative endoscopic marking of intestinal lumen for location of lesions.

o sentinel lymph node localization in pt with breast cancer

c.Classification schedule – antidotes, miscellaneous diagnostic dyes

d.Dosage forms -

PROVAYBLUE - injection IV

50 mg/10 mL (5 mg/mL) single-dose ampule

UROLENE BLUE

• For oral dosage form (tablets):
  • For methemoglobinemia:
    • 100 to 300 milligrams (mg) a day (children and adults)
• For injection dosage form:
  • For methemoglobinemia:
    • Dose is based on body weight or size, usually 1 to 2 mg per kilogram (kg) of body weight, or 25 to 50 mg per square meter of body surface area, injected into a vein over a period of five minutes.

e. Adverse reactions/side effects

1) Methylene blue causes toxicity in high doses that include cardiac arrhythmias, coronary vasoconstriction, decreased cardiac output, renal blood flow and mesenteric blood flow; increased pulmonary vascular pressure & pulmonary vascular resistance and gas exchange deterioration.

2) Peri-tumoral injection of Methylene blue dye in female patients with breast cancer undergoing sentinel lymph node biopsy localization, may causes skin and fat necrosis due to tissue reactive properties.

3) It turns urine greenish blue and bluish discoloration of skin and mucosa and is self limiting.

4) Methylene blue can cause hemolytic anemia characterized by Heinz body formation in patients with severe renal insufficiency and glucose-6-phosphate dehydrogenase (G6PD) deficiency.

5) In neonates, Methylene blue causes hyperbilirubinemia, meth-Hemoglobin formation, hemolytic anemia, respiratory distress, pulmonary edema, photo toxicity and bluish discoloration of tracheal secretions and urine.

6) Methylene blue due to its monoamine oxidase(MAO) inhibiting property may precipitate potentially fatal serotonin toxicity at doses >5mg/kg

f. APA formatted credible source(s)

1) Ginimuge, P. R., & Jyothi, S. D. (2010). Methylene blue: revisited. Journal of anaesthesiology, clinical pharmacology, 26(4), 517.

2) Hughes, B. (2010). 2009 FDA drug approvals.

3) List, D. A. Drugs Information Online Drugs and diseases reference index. Headache, 1(1.5), 5-5.

Gentian violet

a. Generic name

· Gentian violet ((GV)

   Brand name(s)

· Triple Dye,

· Kerr Triple Dye

b. Indications and usage

1) Gentian violet is an antiseptic dye used to treat fungal infections of the skin

2) It has weak antibacterial effects and used on minor cuts and scrapes to prevent infection

3) It has anti-helminithic, anti-trypanosomal, anti-angiogenic and anti-tumor properties.

c. Classification schedule

· Topical antifungals

· Topical anti-infectives

d.Dosage forms

Gention violet 1% topical for fungal infections

e.Adverse reactions/side effects

Signs of inflammation (redness and swelling) at the site of application.

· Allergic reaction is rare that include rash and itching on the face, tongue and throat. In severe condition it may cause dizziness and breathing trouble

f. APA formatted credible source(s)

1) Maley, A. M., & Arbiser, J. L. (2013). Gentian Violet: a 19th century drug re‐emerges in the 21st century. Experimental dermatology, 22(12), 775-780.

Acetic acid

a.Generic name – Acetic acid

Brand name(s)

1) Acetasol

2) Vasotate

3) Domeboro Otic

4) Vinegar

b.Indications and usage

· To treat outer ear infection (external otitis)

c. Classification schedule

§ Antimicrobials

d.Dosage forms

· Otic Solution, USP, containing 2% acetic acid, is available in 15 mL and 30 mL measured-drop,

e. Adverse reactions/side effects

· Tingling or burning in the ear canal may occur immediately after application, that is self limiting in nature

· In over dosage, breathing trouble.

f. APA formatted credible source(s)

1) Schaefer, P., & Baugh, R. F. (2012). Acute otitis externa: an update. American family physician, 86(11), 1055-1061.

Mannitol

a. Generic name - Mannitol Injection

Brand name(s) - Mannitol IV

b.Indications and usage

1. To treat the symptoms of Elevated Intracranial or Intraocular Pressure. Mannitol IV may be used al Promotion of diuresis in the prevention or treatment of the oliguric phase of acute renal failure before irreversible renal failure becomes established.
2. Promotion of urinary excretion of toxic materials.

c.Classification schedule - Diuretics, Osmotic

d.Dosage forms

Adult Mannitol IV - 50 to 200 g in a 24-hour period,

e.Adverse reactions/side effects

1) Fever

2) Infection at the injection site

3) Deep vein thrombosis or DVT

4) Leakage of intravenously infused medication, and

5) Hypervolemia

        Mannitol IV - Dry mouth, runny nose, hypotension

f.APA formatted credible source(s)

1) Warren, S. E., & Blantz, R. C. (1981). Mannitol. Archives of internal medicine, 141(4), 493-497.