naloxone and Heart-Diseases

The author reviews obscure or unusual antidote recommendations, emphasizing antidotes or antidote uses that are not generally acknowledged or that have little experimental or clinical confirmation of their efficacy. Also included are unusual uses of well known antidotes. Among the antidotes considered are naloxone, physostigmine, folate, Prussian blue, n-acetylcysteine, cimetidine, subcutaneous magnesium salts, nicotinamide, and thioctic acid.

Topics: Acetylcysteine; Adult; Aged; Animals; Antidotes; Child; Cimetidine; Female; Ferrocyanides; Folic Acid; Heart Diseases; Humans; Magnesium; Male; Middle Aged; Naloxone; Niacinamide; Physostigmine; Poisoning; Pyridoxine; Thioctic Acid

Naloxone (Narcan) is generally considered to be a narcotic antagonist devoid of pharmacologic activity except for its reversal of opioid (narcotic) effects. Case reports indicate that naloxone in its role of narcotic antagonist may induce hypertension, pulmonary edema, atrial and ventricular arrhythmias, or cardiac arrest in certain patients, particularly those with pre-existing cardiac abnormalities. These adverse effects of naloxone may be due to extreme sympathetic nervous system activity resulting from the reversal of narcotic analgesia, an effect of the drug on peripheral or central opioid receptors or a drug interaction with other anesthetic agents. Any patient given naloxone, particularly in the presence of surgical pain, should be closely monitored for adverse cardiovascular effects.

Topics: Aged; Cardiovascular Diseases; Heart; Heart Diseases; Humans; Male; Middle Aged; Naloxone

Interventions to reduce the cardiotoxicity of doxorubicin are clinically relevant. Pharmacological preconditioning mimicking ischemic preconditioning has been demonstrated with morphine and represents an acceptable clinical intervention. The purpose of this study was to examine if pretreatment in vivo with morphine could reduce doxorubicin-induced cardiotoxicity ex vivo in a rat model. Wistar rats were divided into six groups and pretreated with an intraperitoneal (i.p.) injection of 3 or 10 mg/kg morphine, 1 mg/kg naloxone and saline, 1 mg/kg naloxone and 3 mg/kg morphine or saline, 60 min before excision of the heart. Biochemical indices such as troponin T (TnT) and hydrogen peroxide (H2O2) in effluate were measured together with physiological parameters in Langendorff hearts before and after doxorubicin infusion (2 mg/mL 0.05 mL/min for 45 min). Myocardial content of doxorubicin was measured at the end of infusion. Pretreatment with morphine, irrespective of dosage, produced a significant loss in left ventricular-developed pressure and an increase of TnT and H2O2 in effluate before doxorubicin infusion (p < 0.05). Morphine also produced a significant increase in left ventricular end-diastolic pressure and an increase of TnT and H2O2 in effluate (p < 0.05) at the end of doxorubicin infusion. Naloxone, a non-selective opioid receptor antagonist, abolished the effects of morphine both before and after doxorubicin infusion. Morphine, irrespective of dosage, increased myocardial content of doxorubicin compared to pretreatment with saline (p < 0.05). Pretreatment with morphine is associated with a cardiodepressive effect and enhances cardiotoxicity of doxorubicin measured by increased myocardial accumulation of doxorubicin and physiological and biochemical indices. The negative effects observed in our rat model are abolished by naloxone.

Topics: Animals; Antibiotics, Antineoplastic; Cardiotoxicity; Disease Models, Animal; Doxorubicin; Drug Synergism; Heart Diseases; Hydrogen Peroxide; Male; Morphine; Naloxone; Narcotic Antagonists; Narcotics; Rats; Rats, Wistar; Troponin T

Advanced cardiac life support drugs undergo a wide range of temperature exposures in the prehospital setting. Although manufacturers place temperature restrictions for drug stability on their products, it has been shown that these limits are often exceeded in the prehospital environment. We exposed four different drugs to temperatures of -20 degrees C (-6 degrees F) and 70 degrees C (150 degrees F) and subsequently performed assays to determine their respective chemical stability compared with that of control samples. We determined that no significant difference in chemical structure occurred between the standard sample and the four drugs exposed to extreme temperatures (P > .05). This information has obvious implications in making further recommendations for drug storage. More work to determine bioactivity of temperature-exposed drugs may show results with implications for success in prehospital cardiac resuscitation.

Topics: Analysis of Variance; Atropine; Chromatography, High Pressure Liquid; Cold Temperature; Drug Stability; Drug Storage; Emergency Medical Services; Epinephrine; Evaluation Studies as Topic; Fluorescence Polarization Immunoassay; Gas Chromatography-Mass Spectrometry; Heart Diseases; Hot Temperature; Humans; Lidocaine; Life Support Care; Naloxone

Topics: Adolescent; Adult; Aged; Anesthesia Recovery Period; Anesthesia, General; Child; Child, Preschool; Depression, Chemical; Digestive System Diseases; Fentanyl; Heart Diseases; Humans; Middle Aged; Nalbuphine; Naloxone; Postoperative Care; Respiratory Insufficiency; Wounds and Injuries

Topics: Acetaminophen; Adolescent; Dextropropoxyphene; Drug Combinations; Heart Diseases; Humans; Male; Naloxone