Rectal Foreign Bodies Medication
- Author: David W Munter, MD, MBA; Chief Editor: Steven C Dronen, MD, FAAEM more...
Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications. Agents used in patients with rectal foreign bodies include narcotic analgesics, benzodiazepines, and antibiotics.
Opioid Analgesics
Class Summary
Narcotic analgesics facilitate the visualization and successful removal of the foreign body.
Morphine sulfate (Astramorph PF, Duramorph, MS Contin, Kadian, Oramorph SR)
Morphine is the drug of choice for analgesia in this setting because of its reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Various intravenous (IV) doses are used; the dose is commonly titrated until the desired effect is obtained.
Hydromorphone (Dilaudid, Exalgo)
Hydromorphone is a potent semisynthetic opiate agonist that is structurally similar to morphine. It is approximately 7-8 times as potent as morphine on a milligram-for-milligram basis, with a shorter or similar duration of action.
Fentanyl (Duragesic, Fentora, Onsolis, Actiq, Abstral)
Fentanyl is a synthetic opioid that is 75-200 times more potent than morphine sulfate and has a much shorter half-life. It has less hypotensive effects than morphine and is safer in patients with hyperactive airway disease because there is minimal to no associated histamine release. By itself, fentanyl causes little cardiovascular compromise, although addition of benzodiazepines or other sedatives may result in decreased cardiac output and blood pressure.
Fentanyl is highly lipophilic and protein-bound. Prolonged exposure leads to accumulation in fat and delays weaning process. Consider continuous infusion because of the short half-life of fentanyl.
The parenteral form of fentanyl is the drug of choice for conscious sedation analgesia. It is ideal for analgesic action of short duration during anesthesia and in the immediate postoperative period. It is an excellent choice for pain management and sedation, with a short duration (30-60 min), and is easy to titrate. It is easily and quickly reversed by naloxone. After the initial parenteral dose, subsequent parenteral doses should not be titrated more frequently than every 3-6 hours thereafter.
The transdermal form of fentanyl is used only for chronic pain conditions in opioid-tolerant patients. When the transdermal form is used, pain is controlled in the majority of patients with 72-hour dosing intervals; however, some patients require 48-hour dosing intervals. Transdermal fentanyl is easily and quickly reversed by naloxone.
Anxiolytics, Benzodiazepines
Class Summary
Benzodiazepines facilitate visualization and successful removal of the foreign body. By binding to specific receptor sites, these agents appear to potentiate the effects of gamma-aminobutyrate (GABA) and to facilitate inhibitory GABA neurotransmission, as well as other inhibitory transmitters.
Midazolam
Midazolam is a shorter-acting benzodiazepine sedative-hypnotic that is useful in patients requiring acute or short-term sedation. It is also useful for its amnestic effects.
Penicillins, Penicillinase-Resistant
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Piperacillin and tazobactam sodium (Zosyn)
Piperacillin-tazobactam is a combination of an antipseudomonal penicillin with a beta-lactamase inhibitor. It inhibits biosynthesis of cell wall mucopeptide and is effective during the stage of active multiplication.
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