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NADOLOL (CORGARD)

Description

Non-selective beta blocker drug used to treat:

  1. Hypertension.

  2. Angina.

  3. Atrial fibrillation.

  4. Some inherited arrhythmic syndromes such as catecholaminergic polymorphic ventricular tachycardia (CPVT) and long QT syndrome. See Catecholaminergic polymorphic ventricular tachycardia (CPVT) and Long QT syndrome (LQTS).

  5. Migraine.

Nadolol is also used to reduce the risk of variceal bleeding in patients with portal hypertension.

Dose

Adult

PO 40–80 mg/day (max dose 240 mg).

Special points

Sudden cessation of nadolol may result in rebound effects such as heart attack, CVA, severe hypertension or arrhythmia. It should be weaned over a 1–2 week period.

NALBUPHINE (NUBAIN)

Opioid agonist-antagonist drug. This drug is used to treat pain and, unlike pure opioid agonists, has little to no potential to cause euphoria or respiratory depression.

NALOXONE (NARCAN)

Description

Opioid antagonist drug, used to reverse the effects of opioids, including respiratory depression and pruritis. It acts by competitively blocking the opioid receptors. High-dose naloxone given to an opioid-dependent person can result in acute withdrawal with nausea and vomiting, sweating, tachycardia, hypertension and seizures.

Dose

Adult

For respiratory depression/excessive sedation—IV boluses 50–100 mcg. Acts within 2 min and effects last about 20 min. Repeat doses or an infusion may be required. IV infusion dose 4–5 mcg/kg/h titrated to effect. Nyxoid is a nasal spray version of naloxone. Administer 1 spray every 2–3 min.

For opioid-induced pruritis—40 mcg IV every 5 min to a maximum dose of 240 mcg.

Child—for opioid intoxication

5–10 mcg/kg IV every 2–3 min until desired response achieved.

NALTREXONE

Description

Long-acting opioid antagonist drug used to treat alcohol or substance abuse. It reduces cravings for opioids in patients who have undergone detoxification.

Implications

  1. While on naltrexone, patients will be resistant to the effects of opioids.

  2. After ceasing naltrexone, patients may have greatly increased sensitivity to the effects of opioids and be at increased risk for respiratory depression.

  3. Naltrexone should be ceased for 3 days before surgery.

  4. Use non-opioid pain treatment strategies. See Bariatric surgery.

  5. If patients require PCA, monitor them closely for respiratory depression.

NAUSEA AND VOMITING

NECK HAEMATOMA MANAGEMENT

Description

Haematoma after neck surgery or neck trauma can lead to airway obstruction and death. Surgery that has the potential to cause neck ...

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