Pethidine

1. Pethidine

2. Introduction • Pethidine) (commonly referred to as Demerol) is a fast-acting opioid analgesic drug. • It's an opiate drug (derived from the opiumor poppy الخشخاشplant) so it's rather similar to morphine - in fact, it is a synthetic version of morphine

3. Introduction/2 • Painkilling drugs such as pethidine, should be available wherever a pregnant women give birth, including in: • labor wards, • birth centers and • at a home birth • Pethidine was the first synthetic opioid synthesized in 1932 as a potential anti-spasmodic agent which means that it helps you relax

4. Introduction/3 • Pethidine is indicated for the treatment of moderate to severe pain, and is delivered as its hydrochloride salt in: • tablets, • as a syrup, or by • intramuscular or • intravenous injection

5. Introduction/4 • Like other opioid drugs, pethidine has the potential to cause physical dependence or addiction. • Pethidine may be more likely to be abused than other prescription Opioids, perhaps because of its rapid onset of action

6. Effects • pethidine was consistently associated with: • more euphoria, • difficulty concentrating, • Confusion, and • impaired psychomotor and cognitive performance when administered to healthy volunteers

7. Pethidine and pregnancy • midwife can both prescribe and give injections of pethidine for pain relief during the first stage of labour, . • Midwife doesn't have to consult a doctor first. It is often combined with another drug to control sickness(an anti-emetic) because pethidine often causes sickness.

8. The advantages of pethidine during labour • It can be given by a midwife: there's no need to wait for a doctor • It takes a very short time to take effect • It can help pregnant women to relax. • It won't slow down labour, if you're already in established labour.

9. The advantages of pethidine during labour /2 • It can be used for a home birth, although not all midwives feel comfortable with this. • It may help postpone or avoid having an epidural if contractions is hard to cope with

10. What are its disadvantages? • It provides only limited relief from labour pain • One in three people find opiate drugs such as pethidine unpleasant • It may make patient feel drowsy • It can make pregnant women feel sick or vomit, even if she have an anti-sickness drug. These problems are less likely if the injection is given shortly before delivery of the baby

11. What are its disadvantages?/2 • It may make pregnant women feel dizzy or she may possibly feel elated, or depressed. • It crosses the placenta and may affect the baby's breathing and make the mother drowsy for several days, particularly if the birth progresses more quickly than expected and the baby is born within two hours of the drug being given.An antidote to pethidine may be needed if the baby has breathing problems after the birth. This is given by injection.

12. What are its disadvantages?/3 • It may be more difficult to get breastfeeding started because the drug may affect the baby's rooting and sucking reflexes, which can make it difficult for the baby to feed. Drowsiness in the baby and difficulties with breastfeeding can last for several days after the birth.

13. What are its disadvantages?/4 • Pethidine also passes into breast milk. It should be used with caution in breastfeeding mothers, and only if the expected benefit to the mother is greater than any possible risk to the baby. Seek medical advice from your doctor.

14. Interactions • The sedative effect of this medicine will be increased if this medicine is taken with any of the following, which can also cause drowsiness: • Alcohol • Antipsychotics, e.g. chlorpromazine • Barbiturates, e.g. amobarbital • Benzodiazepines, e.g. diazepam • Certain antiepileptics, such as sodium valproate • Other strong opioid painkillers, e.g. morphine, codeine • Sedating antihistamines, e.g. hydroxyzine • Sleeping tablets, e.g. zopiclone • Tricyclic antidepressants, e.g. amitriptyline.

15. Not to be used in • Pethidine is also relatively contraindicated for use when a patient: • Is suffering from Severely decreased liver or kidney functions. • Has a history of seizures or epilepsy, • Has an enlarged prostate or urinary retention problems, or • Suffers from Underactive thyroid gland (hypothyroidism), • Obstructive airways disease. Slow, shallow breathing (respiratory depression). • People having an acute asthma attack. • People with decreased production of natural steroid hormones by the adrenal glands. Addison's disease • Tumor of the adrenal gland

16. Warning! • If Pethidine is taken for prolonged periods of time the body can become tolerant to it and it may become less effective at relieving pain. This means that with time, higher doses may be needed to control pain. • With prolonged use the body may also become dependent on the medicine and withdrawal symptoms may then occur if the medicine is then stopped suddenly.

17. Adverse effects • The adverse effects of pethidine administration are primarily those of the opioids as a class: • nausea, vomiting, • sedation, • dizziness, or spinning sensation • Diaphoresisالعرق , • Pinpoint pupils (miosis)., • Problems with urinating: urinary retention • Drowsiness.الخمول • Dry mouth. • Headache. • Confusion • Rash or itching

18. Adverse effects/2 • constipation • Feeling weak. • Increased blood flow to the skin on the face. • Feeling of well-being (euphoria) or changes in mood. • False perceptions of things that are not really there. • Slow, shallow breathing (respiratory depression). • Awareness of your heartbeat. • Increased or decreased heart rate (tachycardia). • Low blood pressure (hypotension). • Feeling cold.

19. Over dosage • Over dosage can cause: • muscle flaccidity, • respiratory depression, • cold and clammy skin, • hypotension and • coma