Transcript pethidine

Introduction
• Pethidine) (commonly referred to as
Demerol) is a fast-acting opioid analgesic
drug.
• It's an opiate drug (derived from the
opiumor poppy ‫ الخشخاش‬plant) so it's rather
similar to morphine - in fact, it is a
synthetic version of morphine
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Painkilling drugs such as pethidine, should be
available wherever a pregnant women give
birth, including in:
labor wards,
birth centers and
at a home birth
Pethidine was the first synthetic opioid
synthesized in 1932 as a potential antispasmodic agent which means that it helps
you relax
Introduction/3
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Pethidine is indicated for the treatment of
moderate to severe pain, and is
delivered as its hydrochloride salt in:
tablets,
as a syrup, or by
intramuscular or
intravenous injection
Introduction/4
• Like other opioid drugs, pethidine has the
potential to cause physical dependence or
addiction.
• Pethidine may be more likely to be abused
than other prescription Opioids, perhaps
because of its rapid onset of action
Effects
• pethidine was consistently associated
with:
more euphoria,
difficulty concentrating,
Confusion, and
impaired
psychomotor and cognitive
performance when administered to healthy
volunteers
Pethidine and pregnancy
• midwife can both prescribe and give
injections of pethidine for pain relief during
the first stage of labour, .
• Midwife doesn't have to consult a doctor
first. It is often combined with another drug
to control sickness (an anti-emetic)
because pethidine often causes sickness.
The advantages of pethidine during
labour
• It can be given by a midwife: there's no
need to wait for a doctor
• It takes a very short time to take effect
• It can help pregnant women to relax.
• It won't slow down labour, if you're already
in
established
labour.
The advantages of pethidine
during labour /2
• It can be used for a home birth, although
not all midwives feel comfortable with this.
• It may help postpone or avoid having an
epidural if contractions is hard to cope with
What are its disadvantages?
• It provides only limited relief from labour
pain
• One in three people find opiate drugs such
as pethidine unpleasant
• It may make patient feel drowsy
• It can make pregnant women feel sick or
vomit, even if she have an anti-sickness
drug. These problems are less likely if the
injection is given shortly before delivery of
the baby
What are its disadvantages?/2
• It may make pregnant women feel dizzy or
she may possibly feel elated, or depressed.
• It crosses the placenta and may affect the
baby's breathing and make the mother
drowsy for several days, particularly if the
birth progresses more quickly than expected
and the baby is born within two hours of the
drug
being
given.
An antidote to pethidine may be needed if
the baby has breathing problems after the
birth. This is given by injection.
What are its disadvantages?/3
• It may be more difficult to get
breastfeeding started because the drug
may affect the baby's rooting and sucking
reflexes, which can make it difficult for the
baby to feed. Drowsiness in the baby and
difficulties with breastfeeding can last for
several days after the birth.
What are its disadvantages?/4
• Pethidine also passes into breast milk. It
should be used with caution in
breastfeeding mothers, and only if the
expected benefit to the mother is greater
than any possible risk to the baby. Seek
medical advice from your doctor.
Interactions
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The sedative effect of this medicine will be
increased if this medicine is taken with any of the
following, which can also cause drowsiness:
Alcohol
Antipsychotics, e.g. chlorpromazine
Barbiturates, e.g. amobarbital
Benzodiazepines, e.g. diazepam
Certain antiepileptics, such as sodium valproate
Other strong opioid painkillers, e.g. morphine,
codeine
Sedating antihistamines, e.g. hydroxyzine
Sleeping tablets, e.g. zopiclone
Tricyclic antidepressants, e.g. amitriptyline.
Not to be used in
• Pethidine is also relatively contraindicated for use when
a patient:
 Is suffering from Severely decreased liver or kidney
functions.
 Has a history of seizures or epilepsy,
 Has an enlarged prostate or urinary retention problems,
or
 Suffers from Underactive thyroid gland (hypothyroidism),
 Obstructive airways disease. Slow, shallow breathing
(respiratory depression).
• People having an acute asthma attack.
 People with decreased production of natural steroid
hormones by the adrenal glands. Addison's disease
 Tumor of the adrenal gland
Warning!
• If Pethidine is taken for prolonged periods
of time the body can become tolerant to it
and it may become less effective at
relieving pain. This means that with time,
higher doses may be needed to control
pain.
• With prolonged use the body may also
become dependent on the medicine and
withdrawal symptoms may then occur if
the medicine is then stopped suddenly.
Adverse effects
 The adverse effects of pethidine administration
are primarily those of the opioids as a class:
 nausea, vomiting,
 sedation,
 dizziness, or spinning sensation
 Diaphoresis ‫العرق‬,
 Pinpoint pupils (miosis).,
 Problems with urinating: urinary retention
 Drowsiness.‫الخمول‬
 Dry mouth.
 Headache.
 Confusion
 Rash or itching
Adverse effects/2
 constipation
 Feeling weak.
 Increased blood flow to the skin on the face.
 Feeling of well-being (euphoria) or changes in
mood.
 False perceptions of things that are not really
there.
 Slow,
shallow
breathing
(respiratory
depression).
 Awareness of your heartbeat.
 Increased or decreased heart rate (tachycardia).
 Low blood pressure (hypotension).
 Feeling cold.
Over dosage
• Over dosage can cause:
muscle flaccidity,
respiratory depression,
cold and clammy skin,
hypotension and
coma