Information about Fentanyl
Fentanyl is an opioid analgesic, first synthesized by Janssen Pharmaceutica (Belgium) in the late 1950s, with a potency eighty times that of morphine. Fentanyl was introduced into medical practice in the 1960s as an intravenous anesthetic under the trade name of Sublimaze. Fentanyl has an LD50 of 3.1 milligrams per kilogram in rats, and, 0.03 milligrams per kilogram in monkeys. The LD50 in humans is not known. In the United States, fentanyl is a Schedule II drug.
Fentanyl lozenges are a solid formulation of fentanyl citrate on a stick in the form of a lollipop that dissolves slowly in the mouth for transmucosal absorption. These lozenges are intended for opioid-tolerant individuals and is effective in treating breakthrough cancer pain. It is also useful for breakthrough pain for those suffering bone injuries, severe back pain, neuropathy, arthritis, and some other examples of chronic nonmalignant pain. The unit is a berry-flavored lozenge on a stick which is swabbed on the mucosal surfaces inside the mouth—inside of the cheeks, under and on the tongue and gums—to release the fentanyl quickly into the system. It is most effective when the lozenge is consumed in 15 minutes. The drug is less effective if swallowed, as despite good absorbance from the small intestine there is extensive first pass metabolism, leading to an oral bioavailability of 33%. Fentanyl lozenges are available in six dosages, from 200 to 1600 µg in 200 µg increments (excluding 1000 µg and 1400 µg). These are now available in the United states in generic form,[1] through an FTC consent agreement.[2]
However, most patients find it takes 10-15 minutes to use all of one lozenge, and those with a dry mouth cannot use this route. In addition, nurses are unable to document how much of a lozenge has been used by a patient, making drug records inaccurate. The development of small fentanyl buccal pellets may be much more practical. These are effervescent tablets placed in the cheek and is absorbed through the buccal mucosa. One advantage of such tablets is claimed be quicker absorption into the bloodstream at lower dosage levels.
Fentanyl is frequently given intrathecally as part of spinal anesthesia or epidurally for epidural anesthesia and analgesia. It is also used as a sedative.
Fentanyl is not considered a first line opioid in palliative care—morphine remains the first line choice, fentanyl is regarded as a second line alternative together with oxycodone and sometimes hydromorphone or methadone.
The precise reason for sudden respiratory depression is unclear, but there are several hypotheses:
Illicit use of pharmaceutical fentanyls first appeared in the mid-1970s in the medical community and continues in the present. United States authorities classify fentanyl as a narcotic. To date, over 12 different analogues of fentanyl have been produced clandestinely and identified in the U.S. drug traffic. The biological effects of the fentanyls are similar to those of heroin, with the exception that there is a noticeably less euphoric 'high' associated with the drug and a stronger sedative and analgesic effect. Because the effects of fentanyl last for only a very short time, it is even more addictive than heroin, and regular users may become addicted very quickly. Additionally, fentanyl may be hundreds of times more potent than street heroin, and tends to produce significantly worse respiratory depression, making it somewhat more dangerous than heroin to users — though in some places, it is sold as heroin, often leading to overdoses. Fentanyl is most commonly used orally, but like heroin, can also be smoked, snorted or injected. Many fentanyl overdoses were initially classified as heroin overdoses.[11]
Fentanyl is normally sold on the black market in the form of transdermal fentanyl patches such as Duragesic, diverted from legitimate medical supplies. The patches may be cut up and eaten, or the gel from inside the patch is extracted and smoked by addicts, and so in response to this manufacturers such as Mylan have produced newer forms of fentanyl patches that cannot be abused in this way.[1] Another dosage form of fentanyl which has appeared on the streets are the fentanyl lollipops Actiq, which are sold under the street name of "percopop". The pharmacy retail price ranges from US$16 to US$50 per unit (based on strength of lozenge), with the black market cost anywhere from US$20 to US$60 per unit, depending on the strength. Abuse of fentanyl by individuals without opiate tolerance can be very dangerous and has resulted in numerous deaths.[2] Even those with opiate tolerances are at high risk for overdoses. Once the fentanyl is in the user's system it is extremely difficult to stop its course because of the nature of absortion. Illicitly synthesized fentanyl powder thought to be manufactured in Mexico has also appeared on the US market. Because of the extremely high strength of pure fentanyl powder, it is very difficult to dilute appropriately, and often the resulting mixture may be far too strong and consequently very dangerous. Some heroin dealers mix fentanyl powder with larger amounts of heroin in order to increase potency or compensate for low-quality heroin, and to increase the volume of their product. As of December 2006, a mix of fentanyl and either cocaine or heroin has caused an outbreak in overdose deaths in the United States, heavily concentrated in the cities of Detroit, Philadelphia, Pittsburgh, Milwaukee, Camden, Chicago,[12] Little Rock, and Dallas.[13] The mixture of fentanyl and heroin is known as "magic", among other names, on the street.[14]
Several large quantities of illicitly-produced fentanyl have been seized by U.S. law enforcement agencies. In June 2006, 945 grams of 83% pure fentanyl powder were seized by Border Patrol agents in California from a vehicle which had entered from Mexico.[15] Mexico is the source of much of the illicit fentanyl for sale in the U.S. However, there has been one domestic fentanyl lab discovered by law enforcement, in April 2006 in Azusa, California. The lab was a source of counterfeit 80 mg OxyContin tablets containing fentanyl instead of oxycodone, as well as bulk fentanyl and other drugs.[16][17]
The "china white" form of fentanyl refers to the clandestinely produced analogue α-methylfentanyl (AMF).[18] This has been reported in the literature to be twice the strength of regular fentanyl. The main bonus of the alpha-methyl is it provides a site of resistance to metabolic degradation resulting in a drug with an increased duration.[19]
2nd millennium
Centuries: 19th century - 20th century - 21st century
1920s 1930s 1940s - 1950s - 1960s 1970s 1980s
1950 1951 1952 1953 1954
1955 1956 1957 1958 1959
- -
- The 1950s
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Chemistry
Synthesis
The synthesis of fentanyl (N-phenyl-N-(1-phenethyl-4-piperidinyl)propanamide) by Janssen Pharmaceutica was achieved in four steps, starting from 4-piperidinone hydrochloride. The 4-piperidinone hydrochloride was first reacted with phenethyl bromide to give N-phenethyl-4-piperidinone (NPP). Treatment of the NPP intermediate with aniline followed by reduction with sodium borohydride afforded 4-anilino-N-phenethyl-piperidine (ANPP). finally ANPP and propionic anhydride are reacted to form the amide product.Analogues
The pharmaceutical industry has developed several analogues of fentanyl:- Alfentanil (trade name Alfenta), an ultra-short acting (5–10 minutes) analgesic,
- Sufentanil (trade name Sufenta), a potent analgesic (5 to 10 times more potent than fentanyl) for use in heart surgery.
- Remifentanil (trade name Ultiva), currently the shortest acting opioid, has the benefit of rapid offset, even after prolonged infusions.
- Carfentanil (trade name Wildnil) is an analogue of fentanyl with an analgesic potency 10,000 times that of morphine and is used in veterinary practice to immobilize certain large animals.
Therapeutic use
Fentanyls are extensively used for anesthesia and analgesia, most often in the operating room and intensive care unit. Fentanyl transdermal patch is used in chronic pain management. Fentanyl patches work by releasing fentanyl into body fats, which then slowly release the drug into the blood stream over 72 hours, allowing for long lasting relief from pain. In the past few years, the patches have gone generic and are available for lower costs. Fentanyl patches are manufactured in five patch sizes: 12.5 micrograms/h, 25 µg/h, 50 µg/h, 75 µg/h, and 100 µg/h. Dosage is based on the size of the patch, since the transdermal absorption rate is generally constant at a constant skin temperature. Rate of absorption is dependent on a number of factors. Body temperature, skin type and placement of the patch can have major effects. The different delivery systems used by different makers will also affect individual rates of absorption.Fentanyl lozenges are a solid formulation of fentanyl citrate on a stick in the form of a lollipop that dissolves slowly in the mouth for transmucosal absorption. These lozenges are intended for opioid-tolerant individuals and is effective in treating breakthrough cancer pain. It is also useful for breakthrough pain for those suffering bone injuries, severe back pain, neuropathy, arthritis, and some other examples of chronic nonmalignant pain. The unit is a berry-flavored lozenge on a stick which is swabbed on the mucosal surfaces inside the mouth—inside of the cheeks, under and on the tongue and gums—to release the fentanyl quickly into the system. It is most effective when the lozenge is consumed in 15 minutes. The drug is less effective if swallowed, as despite good absorbance from the small intestine there is extensive first pass metabolism, leading to an oral bioavailability of 33%. Fentanyl lozenges are available in six dosages, from 200 to 1600 µg in 200 µg increments (excluding 1000 µg and 1400 µg). These are now available in the United states in generic form,[1] through an FTC consent agreement.[2]
However, most patients find it takes 10-15 minutes to use all of one lozenge, and those with a dry mouth cannot use this route. In addition, nurses are unable to document how much of a lozenge has been used by a patient, making drug records inaccurate. The development of small fentanyl buccal pellets may be much more practical. These are effervescent tablets placed in the cheek and is absorbed through the buccal mucosa. One advantage of such tablets is claimed be quicker absorption into the bloodstream at lower dosage levels.
Fentanyl is frequently given intrathecally as part of spinal anesthesia or epidurally for epidural anesthesia and analgesia. It is also used as a sedative.
Fentanyl is not considered a first line opioid in palliative care—morphine remains the first line choice, fentanyl is regarded as a second line alternative together with oxycodone and sometimes hydromorphone or methadone.
Adverse effects
Like other lipid soluble drugs, the pharmacodynamics of fentanyl are poorly understood. The manufacturers acknowledge there is no data on the pharmacodynamics of fentanyl in elderly, cachectic or debilitated patients, frequently the type of patient for which transdermal fentanyl is being used. This may explain the increasing number of reports of respiratory depression events since the late 1970s.[3], [4], [5], [6], [7], [8], [9] In 2006 the U.S. Food and Drug Administration started investigating several respiratory deaths.The precise reason for sudden respiratory depression is unclear, but there are several hypotheses:
- Saturation of the body fat compartment in patients with rapid and profound body fat loss (patients with cancer, cardiac or infection-induced cachexia can lose 80% of their body fat).
- Early carbon dioxide retention causing cutaneous vasodilatation (releasing more fentanyl), together with acidosis which reduces protein binding of fentanyl (releasing yet more fentanyl).
- Reduced sedation, losing a useful early warning sign of opioid toxicity, and resulting in levels closer to respiratory depressant levels.
- Patients already stabilised on other opioids but who cannot swallow
- Patients with moderate to severe renal failure
Illicit use
)
Fentanyl powder seized by a Lake County Deputy Sheriff in Painesville, Ohio, where a male subject had been discovered unresponsive and struggling to breathe
Fentanyl is normally sold on the black market in the form of transdermal fentanyl patches such as Duragesic, diverted from legitimate medical supplies. The patches may be cut up and eaten, or the gel from inside the patch is extracted and smoked by addicts, and so in response to this manufacturers such as Mylan have produced newer forms of fentanyl patches that cannot be abused in this way.[1] Another dosage form of fentanyl which has appeared on the streets are the fentanyl lollipops Actiq, which are sold under the street name of "percopop". The pharmacy retail price ranges from US$16 to US$50 per unit (based on strength of lozenge), with the black market cost anywhere from US$20 to US$60 per unit, depending on the strength. Abuse of fentanyl by individuals without opiate tolerance can be very dangerous and has resulted in numerous deaths.[2] Even those with opiate tolerances are at high risk for overdoses. Once the fentanyl is in the user's system it is extremely difficult to stop its course because of the nature of absortion. Illicitly synthesized fentanyl powder thought to be manufactured in Mexico has also appeared on the US market. Because of the extremely high strength of pure fentanyl powder, it is very difficult to dilute appropriately, and often the resulting mixture may be far too strong and consequently very dangerous. Some heroin dealers mix fentanyl powder with larger amounts of heroin in order to increase potency or compensate for low-quality heroin, and to increase the volume of their product. As of December 2006, a mix of fentanyl and either cocaine or heroin has caused an outbreak in overdose deaths in the United States, heavily concentrated in the cities of Detroit, Philadelphia, Pittsburgh, Milwaukee, Camden, Chicago,[12] Little Rock, and Dallas.[13] The mixture of fentanyl and heroin is known as "magic", among other names, on the street.[14]
Several large quantities of illicitly-produced fentanyl have been seized by U.S. law enforcement agencies. In June 2006, 945 grams of 83% pure fentanyl powder were seized by Border Patrol agents in California from a vehicle which had entered from Mexico.[15] Mexico is the source of much of the illicit fentanyl for sale in the U.S. However, there has been one domestic fentanyl lab discovered by law enforcement, in April 2006 in Azusa, California. The lab was a source of counterfeit 80 mg OxyContin tablets containing fentanyl instead of oxycodone, as well as bulk fentanyl and other drugs.[16][17]
The "china white" form of fentanyl refers to the clandestinely produced analogue α-methylfentanyl (AMF).[18] This has been reported in the literature to be twice the strength of regular fentanyl. The main bonus of the alpha-methyl is it provides a site of resistance to metabolic degradation resulting in a drug with an increased duration.[19]
References
1. ^ Barr Pharmaceuticals (2006-09-27). Barr Launches Generic ACTIQ(R) Cancer Pain Management Product. Press release. Retrieved on 2006-09-30.
2. ^ FTC (2004-08-09). With Conditions, FTC Allows Cephalon’s Purchase of CIMA, Protecting Competition for Breakthrough Cancer Pain Drugs. Press release. Retrieved on 2006-09-30.
3. ^ Smydo J. Delayed respiratory depression with fentanyl. Anesthesia Progress. 26(2):47-8, 1979
4. ^ van Leeuwen L. Deen L. Helmers JH. A comparison of alfentanil and fentanyl in short operations with special reference to their duration of action and postoperative respiratory depression. Anaesthesist. 30(8):397-9, 1981
5. ^ Brown DL. Postoperative analgesia following thoracotomy. Danger of delayed respiratory depression. Chest. 88(5):779-80, 1985.
6. ^ Bulow HH. Linnemann M. Berg H. Lang-Jensen T. LaCour S. Jonsson T. Respiratory changes during treatment of postoperative pain with high dose transdermal fentanyl. Acta Anaesthesiologica Scandinavica, 1995; 39(6): 835-9.
7. ^ Nilsson C. Rosberg B. Recurrence of respiratory depression following neurolept analgesia. Acta Anaesthesiologica Scandinavica. 26(3):240-1, 1982
8. ^ McLoughlin R. McQuillan R. Transdermal fentanyl and respiratory depression. Palliative Medicine, 1997; 11(5):419.
9. ^ Regnard C, Pelham A. Severe respiratory depression and sedation with transdermal fentanyl: four case studies. Palliative Medicine, 2003; 17: 714-716.
10. ^ New Anesthetic Agents, Devices, and Monitoring Techniques. Retrieved on 2007-10-20.
11. ^ [Boddiger, D. (2006, August 12). Fentanyl-laced street drugs “kill hundreds”. In EBSCOhost. Retrieved March 7, 2007, from [3] pdf?vid=8&hid=8&sid=e6bcbd34-2854-4beb-bfca-35460dd686e6%40sessionmgr7 ]
12. ^ Press Release by the Chicago Police Department Police report about a death linked to heroin/fentanyl mixture August 24, 2006
13. ^ SMU student's death blamed on rare drug
14. ^ Fentanyl probe nets 3 suspects by Norman Sinclair and Ronald J. Hansen, The Detroit News, June 23, 2006, retrieved June 25, 2006.
15. ^ INTELLIGENCE ALERT: HIGH PURITY FENTANYL SEIZED NEAR WESTMORELAND, CALIFORNIA, DEA Microgram, June 2006
16. ^ INTELLIGENCE ALERT: LARGE FENTANYL / MDA / TMA LABORATORY IN AZUZA, CALIFORNIA - POSSIBLY THE “OC-80” TABLET SOURCE, DEA Microgram, April 2006.
17. ^ INTELLIGENCE ALERT: OXYCONTIN MIMIC TABLETS (CONTAINING FENTANYL) NEAR ATLANTIC, IOWA, DEA Microgram, January 2006.
18. ^ Behind the Identification of China White Analytical Chemistry, 53(12), 1379A-1386A (1981)
19. ^ Van Bever W, Niemegeers C, Janssen P (1974). "Synthetic analgesics. Synthesis and pharmacology of the diastereoisomers of N-(3-methyl-1-(2-phenylethyl)-4-piperidyl)-N-phenylpropanamide and N-(3-methyl-1-(1-methyl-2-phenylethyl)-4-piperidyl)-N-phenylpropanamide". J Med Chem 17 (10): 1047–51. PMID 4420811.
2. ^ FTC (2004-08-09). With Conditions, FTC Allows Cephalon’s Purchase of CIMA, Protecting Competition for Breakthrough Cancer Pain Drugs. Press release. Retrieved on 2006-09-30.
3. ^ Smydo J. Delayed respiratory depression with fentanyl. Anesthesia Progress. 26(2):47-8, 1979
4. ^ van Leeuwen L. Deen L. Helmers JH. A comparison of alfentanil and fentanyl in short operations with special reference to their duration of action and postoperative respiratory depression. Anaesthesist. 30(8):397-9, 1981
5. ^ Brown DL. Postoperative analgesia following thoracotomy. Danger of delayed respiratory depression. Chest. 88(5):779-80, 1985.
6. ^ Bulow HH. Linnemann M. Berg H. Lang-Jensen T. LaCour S. Jonsson T. Respiratory changes during treatment of postoperative pain with high dose transdermal fentanyl. Acta Anaesthesiologica Scandinavica, 1995; 39(6): 835-9.
7. ^ Nilsson C. Rosberg B. Recurrence of respiratory depression following neurolept analgesia. Acta Anaesthesiologica Scandinavica. 26(3):240-1, 1982
8. ^ McLoughlin R. McQuillan R. Transdermal fentanyl and respiratory depression. Palliative Medicine, 1997; 11(5):419.
9. ^ Regnard C, Pelham A. Severe respiratory depression and sedation with transdermal fentanyl: four case studies. Palliative Medicine, 2003; 17: 714-716.
10. ^ New Anesthetic Agents, Devices, and Monitoring Techniques. Retrieved on 2007-10-20.
11. ^ [Boddiger, D. (2006, August 12). Fentanyl-laced street drugs “kill hundreds”. In EBSCOhost. Retrieved March 7, 2007, from [3] pdf?vid=8&hid=8&sid=e6bcbd34-2854-4beb-bfca-35460dd686e6%40sessionmgr7 ]
12. ^ Press Release by the Chicago Police Department Police report about a death linked to heroin/fentanyl mixture August 24, 2006
13. ^ SMU student's death blamed on rare drug
14. ^ Fentanyl probe nets 3 suspects by Norman Sinclair and Ronald J. Hansen, The Detroit News, June 23, 2006, retrieved June 25, 2006.
15. ^ INTELLIGENCE ALERT: HIGH PURITY FENTANYL SEIZED NEAR WESTMORELAND, CALIFORNIA, DEA Microgram, June 2006
16. ^ INTELLIGENCE ALERT: LARGE FENTANYL / MDA / TMA LABORATORY IN AZUZA, CALIFORNIA - POSSIBLY THE “OC-80” TABLET SOURCE, DEA Microgram, April 2006.
17. ^ INTELLIGENCE ALERT: OXYCONTIN MIMIC TABLETS (CONTAINING FENTANYL) NEAR ATLANTIC, IOWA, DEA Microgram, January 2006.
18. ^ Behind the Identification of China White Analytical Chemistry, 53(12), 1379A-1386A (1981)
19. ^ Van Bever W, Niemegeers C, Janssen P (1974). "Synthetic analgesics. Synthesis and pharmacology of the diastereoisomers of N-(3-methyl-1-(2-phenylethyl)-4-piperidyl)-N-phenylpropanamide and N-(3-methyl-1-(1-methyl-2-phenylethyl)-4-piperidyl)-N-phenylpropanamide". J Med Chem 17 (10): 1047–51. PMID 4420811.
- Lehman, K. A., and D. Zech (eds) Transdermal Fentanyl: a new Approach to Prolonged Pain Control, Berlin; New York: Springer-Verlag (1991) ISBN 0387544402
See also
External links
- National Institute of Health (NIH) Medline Plus: Fentanyl
- RxList: Fentanyl
- FDA Public Health Advisory: Fentanyl
- US DEA information: fentanyl
- 08/16/2007 News Release: Cephalon Announces Positive Results from a Pivotal Study of FENTORA in Opioid-tolerant Patients with Non-cancer Breakthrough Pain
- Description of use of Fentanyl in Russia as an incapacitating weapon. See also Moscow theater hostage crisis
- BBC news report on Russian siege story
- Amid fentanyl deaths, investigation, addicts keep using in the Chicago Defender
- Lancaster Online story - New Killer: Fentanyl-Heroin Mix
- Transdermal Fentanyl- Article by:Mr Andrew Dickman (MSc MRPharmS) - Specialist Principal Pharmacist, Palliative Care Team, Whiston Hospital, Merseyside. Published on www.pain-talk.org.uk
Analgesics (N02A, N02B) | |
|---|---|
| Opioids | Buprenorphine, Butorphanol, Codeine, Dextropropoxyphene, Diamorphine, Dihydrocodeine, Fentanyl, Hydrocodone, Hydromorphone, Ketobemidone, Levorphanol, Methadone, Morphine, Nicomorphine, Opium, Oxycodone, Oxymorphone, Pethidine, Tramadol |
| Salicylic acid and derivatives | Aspirin (Acetylsalicylic Acid), Diflunisal, Ethenzamide, Salicin, Salicylamide -- See also: |
| Pyrazolones | Aminophenazone, Metamizole, Phenazone |
| Cannabinoids | Cannabis, Tetrahydrocannabinol, AM404 |
| Anilides | Paracetamol (acetaminophen), Phenacetin |
| Others | Ziconotide, Ibuprofen, Ketoprofen, Mefenamic Acid, Naproxen, Diclofenac, Flurbiprofen, Diflunisal, Indomethacin, Ketorolac, Meloxicam, Piroxicam |
An opioid is a chemical substance that has a morphine-like action in the body. The main use is for pain relief. These agents work by binding to opioid receptors, which are found principally in the central nervous system and the gastrointestinal tract.
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An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). The word analgesic derives from Greek an- ("without") and -algia ("pain").
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Janssen Pharmaceutica, is a pharmaceutical company based in Beerse, Belgium, was established in 1953 by Dr. Paul Janssen. It was created not as a subsidiary of a chemical factory but solely with the aim of conducting pharmacological research.
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Motto
Eendracht maakt macht (Dutch)
L'union fait la force" (French)
Einigkeit macht stark
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Eendracht maakt macht (Dutch)
L'union fait la force" (French)
Einigkeit macht stark
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worldwide view.
2nd millennium
Centuries: 19th century - 20th century - 21st century
1920s 1930s 1940s - 1950s - 1960s 1970s 1980s
1950 1951 1952 1953 1954
1955 1956 1957 1958 1959
- -
- The 1950s
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Centuries: 19th century - 20th century - 21st century
1930s 1940s 1950s - 1960s - 1970s 1980s 1990s
1960 1961 1962 1963 1964
1965 1966 1967 1968 1969
- -
-
Their 1960s decade refers to the years from 1960 to 1969, inclusive.
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1930s 1940s 1950s - 1960s - 1970s 1980s 1990s
1960 1961 1962 1963 1964
1965 1966 1967 1968 1969
- -
-
Their 1960s decade refers to the years from 1960 to 1969, inclusive.
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Anesthesia or anaesthesia (see spelling differences; from Greek αν- an- “without” + αἲσθησις aisthesis
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Janssen Pharmaceutica, is a pharmaceutical company based in Beerse, Belgium, was established in 1953 by Dr. Paul Janssen. It was created not as a subsidiary of a chemical factory but solely with the aim of conducting pharmacological research.
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4-Piperidinone (4-piperidone, piperidin-4-one) is a derivative of piperidine with the molecular formula C5H9NO. 4-Piperidone is used as an intermediate in the manufacture of chemicals and pharmaceutical drugs.
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References
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N-Phenethyl-4-piperidinone (NPP) is a derivative of 4-piperidinone with the molecular formula C5H9NO. 4-Piperidone is used as an intermediate in the manufacture of chemicals and pharmaceutical drugs such as fentanyl.
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Aniline, phenylamine or aminobenzene is an organic compound with the formula C6H5NH2. It is the simplest and one of the most imporant aromatic amines, being used as a precursor to more complex chemicals.
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Sodium borohydride, also known as sodium tetrahydroborate, has the chemical formula NaBH4. This white solid, usually encountered as a powder, is a specialty reducing agent used in the manufacture of pharmaceuticals and other organic and inorganic compounds.
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Propanoic anhydride, also called propionic anhydride, is a simple acid anhydride. With the chemical formula (CH3CH2CO)2O, it is a widely used reagent in organic synthesis.
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Alfentanil (trade name Alfenta) is a potent but short-acting synthetic opioid analgesic drug, used for anaesthesia in surgery. It is an analogue of fentanyl with 10-20% the potency of fentanyl. It is an OP3 mu-agonist.
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Sufentanil is a synthetic opioid analgesic drug approximately 5 to 10 times more potent than fentanyl. Sufentanil is marketed for use by specialist centres under different trade names, such as Sufenta and Sufentil (India, by Claris Lifesciences Ltd.).
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Remifentanil (marketed by Abbott as Ultiva®) is a potent ultra short-acting synthetic opioid analgesic drug. It is given to patients during surgery to relieve pain and as an adjunct to an anaesthetic.
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Carfentanil or Carfentanyl (R33799) is an analogue of the popular synthetic opioid analgesic fentanyl, and is one of the most potent opioids known (also the most potent opioid used commercially). Carfentanil was discovered by Janssen Pharmaceutica.
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Anesthesia or anaesthesia (see spelling differences; from Greek αν- an- “without” + αἲσθησις aisthesis
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An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). The word analgesic derives from Greek an- ("without") and -algia ("pain").
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transdermal patch or skin patch is a medicated adhesive patch that is placed on the skin to deliver a time released dose of medication through the skin and into the bloodstream. A wide variety of pharmaceuticals can be delivered by transdermal patches.
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A generic drug (pl. generic drugs, short: generics) is a drug which is produced and distributed without patent protection. A generic must contain the same active ingredients as the original formulation.
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Most cancer patients will, from time to time, experience pain which is normally treated by pain medications. Pain which lasts for up to 12 hours a day is called persistent cancer pain, and this, too, can be treated, with stronger pain relievers.
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FTC may mean several things:
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- The Federal Trade Commission.
- Ferencvárosi Torna Club, a Hungarian football team.
- Fire Team Charlie, a machinima based on the Halo games.
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Buccal can refer to:
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- The adjective form of cheek
- The "buccal artery", also known as the Buccinator artery
- Buccal nerve
- The 'outer' surface of a tooth Dental caries
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Carbonation occurs when carbon dioxide is dissolved in water or an aqueous solution. This process yields the "fizz" to carbonated water and sparkling mineral water, the head to beer, and the cork pop and bubbles to champagne and sparkling wine.
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Cheeks (Latin: bucca, also malā: "jaw") constitute the area of the face below the eyes and between the nose and the left or right ear.
It is fleshy in humans and other mammals, the skin being suspended by the chin and the jaws, and forming the lateral
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It is fleshy in humans and other mammals, the skin being suspended by the chin and the jaws, and forming the lateral
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Buccal mucosa is mucous membrane of the inside of the cheek. It is non-keratinised and is continuous with the mucosae of the soft palate, under surface of tongue and the floor of the mouth.
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Spinal analgesia, (or commonly called spinal anaesthesia) is a form of local, or more specifically regional, anaesthesia involving injection of a local anaesthetic into the cerebrospinal fluid (CSF), generally through a long fine needle.
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loading dose to initiate the nerve block.
Typically, the effects of the epidural are noted below a specific level on the body (dermatome). This level (the "block height") is chosen by the anaesthetist. The level is usually 3-4 dermatomes higher than the point of insertion.
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Typically, the effects of the epidural are noted below a specific level on the body (dermatome). This level (the "block height") is chosen by the anaesthetist. The level is usually 3-4 dermatomes higher than the point of insertion.
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Herod_Archelaus
