Thursday, June 25, 2009



Meperidine is in a group of drugs called narcotic pain relievers. It is similar to morphine.
Meperidine is used to treat moderate-to-severe pain. It is a synthetic morphine derivative.

Meperidine hydrochloride is ethyl 1-methyl-4-phenylisonipecotate hydrochloride, a white crystalline substance with a melting point of 186°C to 189°C. It is readily soluble in water and has a neutral reaction and a slightly bitter taste. The solution is not decomposed by a short period of boiling


Analgesics, Opioid - Compounds with activity like OPIATE ALKALOIDS, acting at OPIOID RECEPTORS. Properties include induction of ANALGESIA or NARCOSIS.
Adjuvants, Anesthesia - Agents that are administered in association with anesthetics to increase effectiveness, improve delivery, or decrease required dosage.
Narcotics - Agents that induce NARCOSIS. This term is considered outdated due to imprecision but continues to be widely used. Originally, agents that caused somnolence or induced sleep (STUPOR); now, any derivative, natural or synthetic, of OPIUM or MORPHINE or any substance that has their effects. Narcotics are potent inducers of ANALGESIA and OPIOID-RELATED DISORDERS.
Ii also has atropine like action which is parasympatholytic and also has papaverine like action which can give smooth muscle relaxant effect.

Meperidine is a synthetic opiate agonist belonging to the phenylpiperidine class. Meperidine may produce less smooth muscle spasm, constipation, and depression of the cough reflex than equivalent doses of morphine. The onset of action is lightly more rapid than with morphine, and the duration of action is slightly shorter. The chemical structure of Meperidine is similar to local anesthetics. Meperidine is recommended for relief of moderate to severe acute pain and has the unique ability to interrupt postoperative shivering and shaking chills induced by amphotericin B. Meperidine has also been used for intravenous regional anesthesia, peripheral nerve blocks and intraarticular, epidural and spinal analgesia. Meperidine is considered a second-line agent for the treatment of acute pain. Used to control moderate to severe pain.


Meperidine is primarily a kappa-opiate receptor agonist and also has local anesthetic effects. Meperidine has more affinity for the kappa-receptor than morphine. Opiate receptors are coupled with G-protein receptors and function as both positive and negative regulators of synaptic transmission via G-proteins that activate effector proteins. Binding of the opiate stimulates the exchange of GTP for GDP on the G-protein complex. As the effector system is adenylate cyclase and cAMP located at the inner surface of the plasma membrane, opioids decrease intracellular cAMP by inhibiting adenylate cyclase. Subsequently, the release of nociceptive neurotransmitters such as substance P, GABA, dopamine, acetylcholine and noradrenaline is inhibited. Opioids also inhibit the release of vasopressin, somatostatin, insulin and glucagon. Meperidine's analgesic activity is, most likely, due to its conversion to morphine. Opioids close N-type voltage-operated calcium channels (OP2-receptor agonist) and open calcium-dependent inwardly rectifying potassium channels (OP3 and OP1 receptor agonist). This results in hyperpolarization and reduced neuronal excitability.


For Relief of Pain
Dosage should be adjusted according to the severity of the pain and the response of the patient. Meperidine is less effective orally than on parenteral administration. The dose of meperidine should be proportionately reduced (usually by 25 to 50 percent) when administered concomitantly with phenothiazines and many other tranquilizers since they potentiate the action of meperidine.
Adults: The usual dosage is 50 mg to 150 mg orally, every 3 or 4 hours as necessary.
Pediatric Patients: The usual dosage is 1.1 mg/kg to 1.8 mg/kg orally, up to the adult dose, every 3 or 4 hours as necessary.
Each dose of the oral solution should be taken in one-half glass of water, since if taken undiluted, it may exert a slight topical anesthetic effect on mucous membranes.

Pethidine is quickly hydrolysed in the liver to pethidinic acid and is also demethylated to norpethidine, which has half the analgesic activity of pethidine but a longer elimination half-life (8-12 hours[13]); accumulating with regular administration, or in renal failure. Norpethidine is toxic and has convulsant and hallucinogenic effects. The toxic effects mediated by the metabolites cannot be countered with opioid receptor antagonists such as naloxone or naltrexone and are probably primarily due to norpethidine's anticholinergic activity probably due to its structural similarity to atropine though its pharmacology has not been thoroughly explored. The neurotoxicity of pethidine's metabolites is a unique feature of pethidine compared to other opioids. Pethidine's metabolites are further conjugated with glucuronic acid and excreted into the urine.
Difference of meperidine to morphine.
• Its analgesics action is only 10% of morphine with the same dose.
• Its does not depress cough center so have no use to suppress cough.
• In therapeutics dose its does not cause respiratory distress.
• Its does not cause constipation.
• It has atropine like action.
• It does not cause PPP so pupil is dilated.
• Its tolerance and addiction is less than with morphine.

Similarities of morphine to meperidine.
• Stimulation of CTZ which lead to vomiting.
• Also release of ADH.
Therapeutic uses of meperidine.
• As analgesics instead of morphine.
• In obstetrics to reduce labour pain.
• As preanesthetic medication instead of morphine.
• Better than morphine in renal and biliary colics .

Misuse, Abuse, and Diversion of Opioids
Meperidine is an opioid agonist of the morphine-type. Such drugs are sought by drug abusers and people with addiction disorders and are subject to criminal diversion.
Meperidine can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing Meperidine in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion.
Concerns about abuse, addiction, and diversion should not prevent the proper management of pain.
Healthcare professionals should contact their State Professional Licensing Board or State Controlled Substances Authority for information on how to prevent and detect abuse or diversion of this product.
Interactions with Alcohol and Drugs of Abuse
Meperidine may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression.
Head Injury and Increased Intracranial Pressure: The respiratory depressant effects of meperidine and its capacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions, or a preexisting increase in intracranial pressure. Furthermore, narcotics produce adverse reactions which may obscure the clinical course of patients with head injuries. In such patients, meperidine must be used with extreme caution and only if its use is deemed essential.
Asthma and Other Respiratory Conditions: Meperidine should be used with extreme caution in patients having an acute asthmatic attack, patients with chronic obstructive pulmonary disease or cor pulmonale, patients having a substantially decreased respiratory reserve, and patients with preexisting respiratory depression, hypoxia, or hypercapnia. In such patients, even usual therapeutic doses of narcotics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea.
Hypotensive Effect: The administration of meperidine may result in severe hypotension in the postoperative patient or any individual whose ability to maintain blood pressure has been compromised by a depleted blood volume or the administration of drugs such as the phenothiazines or certain anesthetics.
Usage in Ambulatory Patients: Meperidine may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. The patient should be cautioned accordingly.
Meperidine, like other narcotics, may produce orthostatic hypotension in ambulatory patients.
Usage in Pregnancy: Meperidine should not be used in pregnant women prior to the labor period, unless in the judgment of the physician the potential benefits outweigh the possible risks, because safe use in pregnancy prior to labor has not been established relative to possible adverse effects on fetal development.
Labor and Delivery: Meperidine crosses the placental barrier and can produce depression of respiration and psychophysiologic functions in the newborn. Resuscitation may be required
Nursing Mothers: Meperidine appears in the milk of nursing mothers receiving the drug. Due to the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the potential benefits of the drug to the nursing woman.
Symptoms: Serious overdosage with meperidine is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and sometimes bradycardia and hypotension. In severe overdosage, particularly by the intravenous route, apnea, circulatory collapse, cardiac arrest, and death may occur.

Treatment: Primary attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled ventilation. The narcotic antagonist, naloxone hydrochloride, is a specific antidote against respiratory depression which may result from overdosage or unusual sensitivity to narcotics, including meperidine. Therefore, an appropriate dose of this antagonist should be administered, preferably by the intravenous route, simultaneously with efforts at respiratory resuscitation.
An antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression.
• lightheadedness
• dizziness
• weakness
• headache
• extreme calm
• mood changes
• confusion
• agitation
• upset stomach
• vomiting
• stomach pain or cramps
• constipation
• dry mouth
• flushing
• sweating
• changes in vision
Some side effects can be serious. The following symptoms are uncommon.
• slow or difficult breathing
• shaking hands that you cannot control
• muscle twitches or stiffening
• seizures
• hallucination (seeing things or hearing voices that do not exist)
• slow, fast, or pounding heartbeat
• difficulty urinating
• fainting
• rash
• hives

1. Presence of hypersensitivity to narcotics,
2. Diarrhea caused by poisoning (before toxins are eliminated)
3. Bronchial asthma, COPD, cor pulmonale, respiratory depression, anoxia
4. Kyphoscoliosis
5. Acute alcoholism
6. Increased intracranial pressure
7. Pregnancy
Basics and clinical concepts in pharmacology( alexandria university)

tetanus treatment

When a tetanus infection becomes established, treatment usually focuses on :

a) controlling muscle spasms.
b) stopping toxin production
c) neutralizing the effects of the toxin

a) . controlling muscle spasms and supportive treatment.
• Sedatives such as diazepam (Valium) to control muscle spasms , also supportive treatment are given to patient such as Ventilator support to help with breathing in the event of spasms of the vocal cords or the respiratory muscles . other than that IV rehydration also can be given because, as your muscles spasm constantly, increased metabolic demands are placed on your body.
• Analgesics also can be given as needed.
• Patients should be put in quite dark environment to prevent more stimulus that can cause muscle spasm.

b) stopping toxin production
stopping toxin production can be done by administering antibiotics . it is done to kill the causative agent for tetanus which is clostridium tetani. Large doses of antibiotic drugs (such as metronidazole or intramuscular penicillin G) are also given once tetanus infection is suspected, to halt toxin production. Surgical debridement is important to remove the necrotic tissue that is essential for proliferation of the organisms.

c) neutralizing the effects of the toxin
Treatment includes administration of tetanus immune globulin (TIG), which comprises antibodies that inhibit tetanus toxin (also known as tetanus antitoxins), by binding to and removing unbound tetanus toxin from the body. Binding of the toxin to the nerve endings appears to be an irreversible event, and TIG is ineffective at removing bound toxin. Recovery of affected nerves requires the sprouting of a new axon terminal. There are two type of antitoxin, either antitetanic serum (ATS) obtain by immunizing horses with toxoid or hbuman tetanus immunoglobulin (HGIG) which does not have hypersensitivity reaction as a side effect . Antitetanic serum can cause hypersensitivity reaction so a skin sensitivity test should be done.

Sunday, February 1, 2009


i think i feel something today,
but the day seem to be dark,
like it always be,
like a prayer to my soul,
like a dirt on the road,
it always screaming and crying,
pleading with those eager voice,
so sweet it almost hurt,
telling me,
it will always go bad,
no matter who i love,
who i want,
where the person are,
because he knew,
i can never feel anything,
years of peer pressure,
make me crumble,
trying to be like everyone else,
until one day,
i woke up,
not knowing who am i really are.

Friday, July 18, 2008



"Stop running my princess, i am old,i cannot follow your steps anymore" I hear my maid voice from far behind. I am indeed a very energetic princess even in a young age of nine. Beside me, a girl that resemble me in every way except for her blonde hair that contrast to my black silky hair. As dark as my black hair her blonde hair is almost white. She was running beside me, smiling and laughing without a single mark at her cute face showing of tiredness and i am sure that she did not see it either at my face. She is my twin, we were born with the same features except for our hair. My name is vellae that stand for fire and my sister name is vellai that stand for ice. It is not very common for a princess to be name that way because it was usually use by male or warriors, but for every child that were born in the blood line of nobles family especially the prince and princess, their name were choose by the great witches and the names were chosen by them. I don’t know how long they quarrel with each other over our name names and how many time the ritual had to be redone just to make sure that our names really meant to be ours. In the end they just accept it as without further discussion and the announcement of our names
were held only after five months. At least that what we were told when I asked our mother that is Queen Rania about our names. Little did I knew that our name hold much more than we knew or much more than anyone can imagine of.

"this cant be, there must be something wrong with this inscription, these symbols were wrong , everything were just wrong" mumble Joseph alone in his book chamber in one of many towers in the castle ."but what is it, I cant find what wrong with these symbol, it seem right but it also seem very wrong, it seem the translation is right , the story is right, but when it come to the main character, about the warrior, everything is just blurred". That night, just like any other night for seven moths, Joseph cannot sleep well as the dream keep coming and coming, invading his dream like a shadow of power that keep forcing him to read these symbols from the inscription. The inscription is the oldest inscription ever found, it were found in an ancient tomb under this very castle, the tomb of the past king and his queen and predicted to be over five thousand year. Joseph doesn’t know why he keep dreaming about it , the inscription already being translated by the former witch fifty years ago. Joseph also did not know why these dream choose him, he was only the student of witch craft that one day will serve the king just like other king witches . Even though he shows a bright talent at a very young age of fifteen , he is nothing more than a beginner. He know that repeated dream always meant something and usually indicated the path that a witch should go. He never tell anybody his dream because he was so afraid that someone will accused him to be indulge in black magic. He knew his dream is nothing but anger of some past spirit, a very powerful spirit that were likely to be a very powerful human when still alive and these spirit usually a final indicator for witch that they were born to black magic and will die in black magic. This is how a witch knew which path they should follow, but those spirit usually came in a form of ghost or in the form of demon or monster not in the form of shadow and try to force someone to read symbols from old inscription. For that Joseph knew that these dream meant something else. There something in this inscription that important enough for a sleeping spirit that powerful to wake up .

That morning vellai and I went to the garden behind our castle, just like what we will do every morning. It is not the beautiful flowers of the royal garden that we intend to see nor to play hide and seek just like every young princess will do but it is a hole at the garden fence that invited us there every morning. Through that hole vellai and I can find a short cut to the Land of sword. It is a place where our four brothers Gareth, George, Garey and Gyle will receive their training in the art of sword every morning. Their teacher is a handsome man at the age of thirty . He is a very powerful man that were said to hold the power at stage nine. He hold the tremendous power after practicing over twenty years. He was born to be a warrior and he definitely want to die as one. His power is mostly about the power of the earth , stage nine power will let him to create a powerful earth quake or will let him to control earth element such as stone and soil. Most warriors can detect others warriors power especially others who hold less power than he is and so do this man. He also a great teacher as Gareth , my oldest brother has already achieve level two power after three years of strict practice. We were there every morning so we can watch their steps and try to practice that steps when we were alone in our princess chamber. It is not like we did not know that what we were doing is not right and not normal but we can never win over our desire to be strong and to be powerful as it is written in our fate so deep that we cannot resist it. We always felt like there is a destiny waiting for us and wanting us to be prepared for it. Even though it is sound totally weird and definitely stupid but it is exactly what we felt and it is not like those steps is hard to follow and even today we were watching our brothers practicing their steps with total focus, we only focus to the teacher who name is Nemesis because we already finished mastering all the steps that he always use and hoping he will start practicing level ten steps. One thing we never understand why he never relies we were there every morning and why that our brother make it look like it is very hard to master the steps and why I never felt anything powerful about my self even though we always can detect others warriors aura from miles away but we just never totally use ours powers. I don’t even know what exactly my power is nor vellai know what her power is.

" oh, no. why that Nemesis is practicing the same steps, I am bored to death here. These are steps for stage nine right, but why did he still practicing it." Mumble Vellai . " relax, my dear sister, we can practice other steps or we can sneak into the royal library and we can see the old inscription there. There are a lot of old book and paper there, we might find an interesting new subject to play with." I said to my sister and found a nice smile appear at her face showing some eagerness. After spending about ten more minutes in the bushes we found our way back to the royal garden and proceed to go to the royal library. It is well known at that time that female do not read nor write but for us it is stupid and we will never follow the unwritten rule. We are a princess, the only princess that ever born in this royal family after so many generation. It is true that never before in my family born a princess not to say a twin princess but whether it is a gift like everybody said or it is a curse that we were born. Since the day I can remember I knew we are special and nothing can do anything to stop us. To stand for our dignity and an unknown proud we learn how to fight, to read , to write and we decided it is time for us to start to learn about witch craft. It is not just proud in our blood that draw us to this path but it more about the bare and boring life of being princess that keep our heart bleeding. So we find this practice, never ending learning and the danger of breaking rules are rather more excite and entertains. It is understandable right. The more we learn about this world and its contain, the knowledge, the power and its never ending stories the more we want to conquer it.

"vellai, how about we go to the witch book chamber, I heard it is in the west tower and there is something really interesting in it." I tell vellai as we make our pace to the library. "you are absolutely right, I heard there is an old inscription being guard in it, and I also heard from Gyle that this inscription is about five thousand years old. I bet it is written in old symbol" said Vellai answering my idea. So we walk slowly to the west tower, holding each other hand, so calm that we never knew what lies ahead us. After about twenty minutes of leisure walking, we arrived at front gate of the tower. There are about four man were guarding the main gate to enter the west tower. But that is not something to worry about as we are the princess of this kingdom. " vellae, do you feel what I feel, or it is just me that feel a bit weird about this tower." Ask vellai to me just before we make our move to ask the soldier to let us enter. It is not full nonsense about what she ask me because I swear my heart throb like hell at that moment. It is like what we feel when the dark cloud suddenly appeared in a bright day light. "Er, vellai, should we or should we not enter this tower, I feel kind of weird myself." But suddenly I get this sharp pain in my chest like an arrow hitting my chest but there is no arrow nor blood and I can see that vellai felt the same thing as she just stare blankly at me touching her chest. At that time we cant here anything, everything just when black and then the light come. There is a voice so strong that I think my head could explode. " enter my princess, take what exactly was given to you even before you were born , if just you survive this pain." Than the voice gone but the pain remain, I cannot breath, I tried to ask for help from the soldiers bur they seem like they cannot see us. Vellai is already on the ground gasping for air like a fish on the land. The pain continue and never go away but I think I can breath a bit after half an hour. So do vellai as she start standing again. Than we look each other and hold our trembling hand together as we tried to think how to released our self from the pain. And then all we can do is use our sleeping strength that we keep deep in our soul to control it. As if like an explosion in every cells in our body we passed out. It like there is power that keep us in the shadow as the soldier and the maid passing in front of us without even noticing there are two princess were lying on the grass. it is already night when I finally open my eyes and felt every single part in my bodies were aching with pain but it is not the same sharp pain I was feeling few hours ago, it is more like a weak pain that you felt after a tiresome journey. So I know I survive what ever happen to us. Than I look at vellai who suddenly make a mourning voice. Than I know she survive too. " shit, what the hell is that, what just happen to us and it was hurt like hell " I don’t know where she get that all the cursed and beautifully put it in a sentence as we never cursed before. But what can I say it is hurt like hell." I don’t know but thank to god we survive what ever it is" " so my sister, where do you got all that cursed and since when that you start to curse, I am impressed you know" I said it with a smile in my face to make sure she knew that I am not angry." Hehe , we were been to the land of sword so many time that I learn more than the art of sword. The warriors there like to curse pretty much , right"

After that me and vellai went straight to the royal doctor to seek for medicine for our arching bodies." My body felt like I been hit by a horse carriage and my head felt dizzy , and please can you speak slowly, your voice hurt my head" I said to the royal doctor when he began to over reacted over the bruises that appear from nowhere all over my body and he even scream a bit when he look at vellai's body. " oh my god , what happen my princess, who did this to you two, why there are a lot of bruises on your body, tell me my princess, so we can bring this matter to the head soldier and who ever did this to you can be sent to death, oh my poor princess, why something like this happen to you. I merely can stand the sight of the bruises on your body."
Said the royal doctor non stop." There you did it again , don’t I told you to speak slowly, my head felt it like to explode. Why did you ask all these questions anyway, it is my body that is hurt, not yours," I said to the doctor not quite care what happen to my body, it can be healed but what more important is what actually happen to us and why it happen to us. I really sure that what happen to us back there is what we all called death. Well at least it felt like death. The problem is my mind is numb and my brain is functionless at this moment. I cannot think of anything reasonable to explain what happen to us, it is too weird and too nonsense. " I think I am going to be crazy and I am going to declare myself the crazy princess" said Vellai to the royal doctor and I swear his eyes really look like it going to pop out of it socket. " oh my princess please do not say that, it hurt my heart that you, the only princess in this mighty kingdom have to suffer like this. You both are the light of this country, the beautiful flower that d├ęcor the inner peace of this palace, the most magnificent diamond on a royal crown. You both were born to feel happy and be the princess that you were born to be and this is not what you have to experienced my princess " said the royal doctor with a full enthusiasm in his word while holding vellai bruises hand. I don’t know what will any other princess will feel hearing those words, it is suppose to make us feel happy but deep down it hurt my feeling that we, the princess will only be light, some flower in a palace and a diamond . " why must we become the light or some flower or a diamond, MR. doctor, why cant we become something more than some decoration to this perfect palace, why cant we become something more than a princess. Why you have act like we both were killed, it is just bruises and some pain in my head . cant you just give us the medicine, I believe that vellai and me need a rest. It been a very long day. " I cant believe I said that to the doctor, I am sure he just trying to make us feel happy by saying those words but vellai's eyes told me everything . those word really hurt her feeling and I think it is what we both should work for. To be something more than a mere princess that their only destiny is to marry some ugly prince from some rich country. " oh my princess, why did you say that like you feel like being a princess is not enough" said the doctor to me with an eyes full with question. " you right, we never want to be a princess, it is not our destiny, we were born for something more and being a princess is not one of it. Believe me, that one day you will see vellai and me standing in front of every one without the title princess and you all still can be very proud with us." I said that to the doctor not only as promise to him but also as promise to myself and to vellai." You see, I am now princess villae seal this promise to you in every cell of my blood and as the mother of earth watch what happen to us today, I promise these words to you, and do not ever ask me why I make this promise to you because I don’t think I can answer that question. It is just felt right." I said these word out of now where and it certainly make the doctor felt very surprise as who will ever thought a princess will called the blood promise. It is the highest form of promise a royal blood can give to their subject and I just pledge the promise to him. I thought he will feel happy hearing those promise from me but I thought I made a mistake there because he look terrified and scare beyond any reason. I don’t know why exactly but the doctor look way to scare to even reacted to what I am just saying. "hehe ,, are okay because you will make yourself look more older than a fifteen years old witch doctor . say something can you, helloooooooooooo" I have to scream to make him blink his eyes. "what wrong, you look scare and I want to know why" said vellai to the doctor. " well my princess, my name is joseph, I am a student in the art of magic , my teacher is the head witch of this country and my minor is medicine, that why I am a doctor as well" said the doctor slowly or should I call him joseph now." Err, joseph, thank you your briefing about your interesting life, but that still does not answer why do you look scare just now. I was giving you the blood promise you know, you should feel proud." Somehow I pray I never said that because the answer is not what ordinary people want to hear, forever. " my princess, I am the witch doctor that responsible to guard the ancient inscription that was located in the west tower and I am doing some research about it. Believe me that your blood promise just now is really the same as what the inscription had said. It is one of the first promise that the warrior of the fire ever made. The pledge is made in font of the guardian of the destiny and also in front of the other warrior that called the warrior of the ice. The promise is made right after the brothers wake up from death, oh my, what am thinking of course it is just and accident, right" said joseph with a very intense looking face half hoping he was right and half hoping he was wrong. " well, joseph, does this inscription really said that the warriors is brothers or the warrior can also be sisters.

No one can describe how joseph 's face look at that time, he seem to be too in shock and also too scared. " hei, what wrong with you, I know that is not possible and I am just kidding," I said to him, but the look in his face did not change a little and I can never imagine someone as handsome as he can look so worried. Alright I knew that our born is not as simple as other princess but I do want to solve this maze of questions so starting from that very moment I make a mental note that we are going to lay our hand on this so called inscription.

Sunday, July 6, 2008



Monday, June 30, 2008






Sunday, June 8, 2008