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bbb

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sherif kamal

on 3 December 2012

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Transcript of bbb

THANK YOU Dosage & administration
Postoperative recommended adult dose of is 10-20 mg/70kg administered IV &may be repeated every 3-6 hours as necessary.
Premedication:0.1-0.2mg/kg.
Induction:0.3-1g/kg over a period of 10-15 min.
Intraoperative analgesia:0.25-0.5mg/kg at 30 min interval.
Nalbuphine hydrochloride 20 mg 10- Howard J., Nalbuphine a Safe, Effective Long-Term Therapy for Severe Chronic Pain, American Journal of Pain Management , 16: pp. 29, 2006. In Cancer & Severe Chronic pain

Nalbuphine (Nalufin®) proved to be safe, effective long-term therapy for Cancer & severe chronic pain.


Nalbuphine (Nalufin®) effectively reduced long-standing debilitating pain from variety of causes & conditions without inducing any observable withdrawal.10
Nalbuphine hydrochloride 20 mg 11-Sweetman S., Analgesics Anti-inflammatory Drugs and Antipyretics, Martindale
The Complete Drug Reference, 36th edition, pp. 1, 2009. Low Abuse Potential
A WHO expert committee considered in 1989 that likelihood of nalbuphine (Nalufin®) abuse was low to moderate and was not great enough to warrant international control.*

Abuse had been reported infrequently and the withdrawal syndrome produced when naloxone was given after continuous nalbuphine (Nalufin®) dosage was less severe than that in morphine dependence. 11
Nalbuphine hydrochloride 20 mg 7-Narcotic Agonist Analgesics, Drug Facts & Comparisons, pp. 942, 59th edition, 2005
10- Howard J., Nalbuphine a Safe, Effective Long-Term Therapy for Severe Chronic Pain, American Journal of Pain Management , 16: pp. 29, 2006.
Nalbuphine hydrochloride 20 mg
Mixed agonist-antagonist opioid
How Aggressive is Pain..
Pain Becomes No More a Problem 7-Narcotic Agonist Analgesics, Drug Facts & Comparisons, pp. 942, 59th edition, 2005 Ceiling Effect

In contrast to morphine, Nalufin® exhibits a ceiling effect; increases in dosage beyond 30 mg produce no further respiratory depression. 7
Nalbuphine hydrochloride 20 mg 4-Carroll I. et al, Management of Perioperative Pain in Patients Chronically consuming opioids, Regional Anesthesia and Pain Medicine, vol 29, No 6, pp. 576, 2004.. Consequences of Poorly Managed Acute Pain
14- Brock-Utne J. et al, A Comparison of nalbuphine and pethidine for postoperative pain relief after orthopaedic surgery, South African Medical Journal, 68: pp. 391, 1985. For Intraoperative & Postoperative Analgesia Nalufin® proves to be a useful substitute for pethidine
Nalbuphine (Nalufin®) has been reported to be of longer duration & with fewer respiratory & cardiovascular side effects than pethidine for postoperative pain relief after orthopedic surgery. 14
Nalbuphine hydrochloride 20 mg 13- Minai F. & Khan F., A Comparison of Morphine and Nalbuphine for Intraoperative and Postoperative Analgesia, Journal of the Pakistan Medical Association, 53(9): pp. 391, 2003.. For Intraoperative & Postoperative Analgesia Nalufin® provides better analgesia & haemodynamic stability than morphine
Nalbuphine (Nalufin®) provided better analgesia and greater haemodynamic stability, as a component of balanced anaesthesia, with a lower incidence of nausea & vomiting in the postoperative period compared to morphine in patients undergoing total abdominal hysterectomy.13
Nalbuphine hydrochloride 20 mg
How Aggressive is Pain..
Pain Becomes No More a Problem Potent analgesic equipotent with morphine
No further respiratory depression in dose greater than 30 mg
Low abuse potential compared with morphine and other strong opioid agonists
Low incidence of nausea & vomiting compared to morphine & pethidine
No significant hemodynamic effects
Quick onset & long lasting analgesia
Nalbuphine hydrochloride 20 mg 6-Dollery C., Nalbuphine (hydrochloride), Therapeutic Drugs, 2nd edition, p. N 14, 1999.
8-Harvey R. & Champe P., Opioids, Lippincott’s Illustrated Reviews: Pharmacology, 4th edition, pp. 159, 2009. (6,8) Rapid onset of action 2-3 minutes after IV injection & in less than 15 minutes of SC or IM injection.
Half-life 5 hours.
Duration of action 3-6 hours.
Peak plasma concentrations after IM injection are achieved after 15-30 minutes. Quick onset & long lasting analgesia
Nalbuphine hydrochloride 20 mg Low incidence of nausea & vomiting 6-Dollery C., Nalbuphine (hydrochloride), Therapeutic Drugs, 2nd edition, p. N 14, 1999.
12-Brunton L., Opioid Analgesics, Goodman & Gilman’s The Pharmacological Basis of Therapeutics,11th edition, pp. 547, 2006. 9-Rang H. et al, Analgesic dugs, Pharmacology, 5th edition, pp. 562, 2003.
11-Sweetman S., Analgesics Anti-inflammatory Drugs and Antipyretics, Martindale The Complete Drug Reference, 36th edition, pp. 1, 2009. No Hemodynamic Effects of Importance
Nalufin® (nalbuphine HCl) has minimal hemodynamic effects.6

Morphine and some other opioids provoke release of histamine, which sometimes play a large role in the hypotension. 12
Nalufin® (nalbuphine HCl) is of lower incidence of nausea & vomiting than that associated with other opioids.11

Nausea & vomiting occur in up to 40% of patients when they first take morphine.9
Nalbuphine hydrochloride 20 mg 9-Rang H. et al, Analgesic dugs, Pharmacology, 5th edition, pp. 562, 2003. Analgesia   Mu (µ) opioid receptor Kappa (K) opioid receptor 5 3 3-Organization W. Analgesic Ladder. World Health Organization, 1986
5- Gunion M. et al, Use of the mixed agonist-antagonist nalbuphine in opioid based analgesia, Acute Pain, pp. 29, 2004. Opioids are the mainstay therapy for alleviating moderate to severe pain and provide the most effective pain relief of any class of agents * e.g. Paracetamol, aspirin, or NSAID
** e.g. Antidepressants, anticonvulsants
*** e.g. Codeine, tramadol, etc
**** e.g. Morphine, fentanyl, etc WHO 3-Step Analgesic Ladder 3 1 2 Strong opioid ****analgesic
± Non-opioid analgesic
± adjuvant Weak opioid ***analgesic
±Non-opioid analgesic
± adjuvant Non-opioid analgesic*
± adjuvant* * 10- Howard J., Nalbuphine a Safe, Effective Long-Term Therapy for Severe Chronic Pain, American Journal of Pain Management , 16: pp. 29, 2006. Nalufin® achieves analgesia equipotent to morphine but without the respiratory depression, sedation, euphoria, tolerance & other side effects associated with opiates. 10 9-Rang H. et al, Analgesic dugs, Pharmacology, 5th edition, pp. 562, 2003. Opioids side effects   Mu (µ) opioid receptor Kappa (K) opioid receptor 4-Carroll I. et al, Management of Perioperative Pain in Patients Chronically consuming opioids, Regional Anesthesia and Pain Medicine, vol 29, No 6, pp. 576, 2004.. Consequences of Poorly Managed Acute Pain 4-Carroll I. et al, Management of Perioperative Pain in Patients Chronically consuming opioids, Regional Anesthesia and Pain Medicine, vol 29, No 6, pp. 576, 2004.. Consequences of Poorly Managed Acute Pain 5 3 3-Organization W. Analgesic Ladder. World Health Organization, 1986
5- Gunion M. et al, Use of the mixed agonist-antagonist nalbuphine in opioid based analgesia, Acute Pain, pp. 29, 2004. Opioids are the mainstay therapy for alleviating moderate to severe pain and provide the most effective pain relief of any class of agents * e.g. Paracetamol, aspirin, or NSAID
** e.g. Antidepressants, anticonvulsants
*** e.g. Codeine, tramadol, etc
**** e.g. Morphine, fentanyl, etc WHO 3-Step Analgesic Ladder 3 1 2 Strong opioid ****analgesic
± Non-opioid analgesic
± adjuvant Weak opioid ***analgesic
±Non-opioid analgesic
± adjuvant Non-opioid analgesic*
± adjuvant* *
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