NAME THAT DRUG
BY DAWN HAHN, QUEST DIAGNOSTICS The Way You Make Me Feel T
his edition of “Name that Drug” showcases a synthetic drug created in the 1970s in the
United Kingdom. Te mystery drug was developed by the Imperial Chemical Industries (ICI) company, known today as AstraZeneca. Since this drug is only marginally soluble in water, the original formulation was prepared using a surfactant consisting of castor oil and ethylene oxide. During clinical trials in 1977, individuals experienced severe pain at the injection site and developed severe allergic reactions, prompting a change in the drug’s formulation. Te reformulated product was made available again in 1986 by ICI as a suspension of the drug in soya oil and water, which the FDA approved for use beginning in October 1989. Currently, the drug is given as a mixture comprised of soybean oil, glycerol and purified egg phospholipids as emulsifiers. Consequently, people with soy and egg sensitivities should not be treated with this mystery compound. Te drug is included on the 2015 World Health Organization’s Model List of Essential Medicines and is used in hospitals, clinics and healthcare facilities approximately 50 million times each year in the United States. Te mystery drug is administered
by intravenous injection and produces amnesia-like effects on its subjects, serving as an “induction agent” for general anesthesia in major surgery, and as a sedative in mechanically ventilated adults and during endoscopic procedures (e.g., colonoscopies). Tis mystery compound largely replaced the barbiturate known as sodium thiopental (Pentothal®) for the primary induction and maintenance of anesthesia as our mystery drug causes loss of consciousness or “conscious sedation” very rapidly (1 to 3 minutes) in both adult and pediatric patients. Of clinical relevance,
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from the European Union to reduce the exportation of the drug if it were to be used for the execution of prisoners. While considered an off-market use, our mystery drug is also believed to be utilized for human euthanasia of individuals receiving palliative care. Although rare, the recreational use
the drug facilitates both a fast induction and recovery, and patients are less “foggy” when they awaken from surgery. It does not produce vomiting or nausea, which is oſten experienced with opioid medication(s) used during surgical procedures. Interestingly, the anesthetic agent
Pentothal had been one of the three drugs used to execute prisoners by lethal injection in the United States In light of this, the manufacturer stopped producing the drug and the European Union prohibited the export of Pentothal for this intent. As a result of this ban, in 2013 the Missouri Supreme Court decided that our mystery drug could be used as an alternative drug to execute prisoners sentenced to death. However, the drug was never officially used for this purpose because the first scheduled execution using this drug was ceased on October 11, 2013, by Governor Jay Nixon. Tis decision was reached in response to threats
and abuse of our mystery drug have been reported. Te drug’s short-term effects have been described as enjoyable, similar to an alcohol buzz, but dissimilar to a benzodiazepine-like drug high. Despite memory impairment, abuse continues as the desired effects of the drug include pleasant hallucinations and sexual dis-inhibition. Abuse has been primarily reported among medical professionals, especially anesthetists working rotations. In this context, it is self- administered to help with rest during the short periods of time between rotations. Addiction has been reported with long- term use, but the drug’s potency and the enforcement of monitoring programs have minimized its abuse potential. Nonetheless, serious injuries and fatalities have been documented. Similar to some benzodiazepines,
our mystery drug acts as a short-acting sedative-hypnotic agent with sleep- inducing effects in the brain. As with many general anesthetics, the precise mechanism of action is not well understood. Side effects of the drug include pain on injection, which may occur more frequently when smaller veins are used, and can be alleviated by pretreatment with lidocaine. Induction of anesthesia with our drug may cause disruption in breathing (apnea), with adverse effects on heart rate and blood pressure observed in both pediatric and adult patients. On occasion, opioid analgesics have been shown to exacerbate the effect our drug has on blood pressure. Te respiratory effects of the drug
Fall 2015
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