tromethamine


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tromethamine

 [tro-meth´ah-mēn]
an alkalizer used intravenously in treatment of metabolic acidosis. It is also used to make buffer solutions.

tromethamine

Tham

Pharmacologic class: Protein substrate

Therapeutic class: Systemic alkalizer

Pregnancy risk category C

Action

Combines with hydrogen ions to form bicarbonate and a buffer, correcting acidosis. Also shows some diuretic activity.

Availability

Injection: 18 g/500 ml

Indications and dosages

Metabolic acidosis associated with cardiac bypass surgery

Adults: 9 ml/kg (0.32 g/kg) by slow I.V. infusion; 500 ml (18 g) is usually adequate. Maximum single dosage is 500 mg/kg infused over at least 1 hour.

Metabolic acidosis associated with cardiac arrest

Adults: 3.6 to 10.8 g by I.V. injection into large peripheral vein if chest isn't open, or 2 to 6 g I.V. directly into ventricular cavity if chest is open. After reversal of cardiac arrest, patient may need additional amounts to control persistent acidosis.

To correct acidity of acid-citrate-dextrose (ACD) blood in cardiac bypass surgery

Adults: 0.5 to 2.5 g added to each 500 ml of ACD blood used for priming pump-oxygenator. Usual dosage is 2 g.

Dosage adjustment

• Elderly patients

Contraindications

• Hypersensitivity to drug

• Anuria

• Uremia

Precautions

Use cautiously in:

• renal disease, severe respiratory disease, respiratory depression

• pregnant patients

• infants.

Administration

Keep intubation equipment nearby in case respiratory depression occurs.

• For metabolic acidosis associated with cardiac bypass surgery, give by slow I.V. infusion through large-bore I.V. catheter into large antecubital vein. Elevate arm after infusion.

• If extravasation occurs, discontinue drug and infiltrate affected area with 1% procaine hydrochloride (containing hyaluronidase).

• Be aware that in cardiac arrest, drug is used with standard resuscitative measures. When giving by direct I.V. injection into open chest, never inject into cardiac muscle.

Adverse reactions

GU: oliguria

Hepatic: hemorrhagic hepatic necrosis

Metabolic: metabolic alkalosis, transient hypoglycemia, fluid-solute overload, hyperkalemia

Respiratory: respiratory depression

Other: fever; I.V. site infection; extravasation with venous thrombosis or phlebitis, inflammation, necrosis, and sloughing

Interactions

Drug-diagnostic tests. Glucose: decreased level

Potassium: increased level

Patient monitoring

• Maintain continuous cardiac monitoring.

• Monitor arterial blood gas levels. Watch for alkalosis and signs and symptoms of respiratory depression.

• Assess liver function tests. Stay alert for signs and symptoms of hepatic impairment.

• Monitor glucose and potassium levels. Watch for hypoglycemia and hyperkalemia.

• Closely monitor fluid intake and output. Check for fluid and electrolyte imbalances and oliguria related to hyperkalemia.

Patient teaching

• Explain drug therapy to patient. Assure him he will be monitored continuously.

• As appropriate, review all significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above.

tro·meth·a·mine

(trō-meth'ă-mēn),
A weakly basic compound used as an alkalizing agent and as a buffer in enzymic reactions.
References in periodicals archive ?
Ketorolac tromethamine for injection is available in the United States in 15-, 30-, and 60-mg single-dose vials.
- UK-based Cycle Pharmaceuticals Ltd has received approval from the US Food and Drug Administration of its Abbreviated New Drug Application for Ketorolac Tromethamine Tablets 10mg, the company said.
Generally, the analgesia that is used in postoperative period in this surgical setting was ketorolac tromethamine. It is generally a safe NSAID with moderate analgesic potential.
Comparison of ketorolac tromethamine, diclofenac sodium and loteprednol etabonate in an animal model of ocular inflammation.
Chou, "Preoperative ketorolac tromethamine 0.4% in phacoemulsification outcomes: pharmacokinetic-response curve," Journal of Cataract and Refractive Surgery, vol.
The reference solutions and samples used are of a concentration of 10 [micro]g/L of ketorolac, using ketorolac tromethamine reference substance, which is dissolved in chromatographic grade methanol.
Oral fosfomycin is typically administered using the fosfomycin tromethamine (FT) formulation due to superior bioavailability (~40%) versus fosfomycin calcium (~12%) [10].
qd+ Amitriptyline tablet 25mg, Q.N.+ Clonidazepam tablet 2mg, Q.N.+ Ketorolac Tromethamine Injection 30mg/Nacl 100ml, Ivgtt.t.i.d.; 5 Gabapentin capsule 600mg,t.i.d.
invert sugar, 10, in Ringer's lactate solution with tromethamine (THAM-E) 12 G, calcium chloride 3 G and heparin 18,000 units added.
Patients in Group-1, who were pretreated with diclofenac 0.1% had lower mean pain score (2.57 +- 0.67) in the early phase of study i.e.36 hours post-operatively than the eyes that received ketorolac tromethamine 0.5% (3.20 +- 0.61).
Pharmaceutical company Egalet Corporation (Nasdaq:EGLT) said on Tuesday that it has begun the promotional campaigning of SPRIX (ketorolac tromethamine) Nasal Spray to more than 9,000 women's healthcare practitioners (HCPs) via an agreement with its partner Ascend Therapeutics .
The cows in Group-I and II were treated intramuscularly with 5 mg Methyl ergometrine maleate (Nexbolic (a)) and 25 mg of Dinoprost tromethamine, a natural PG[F.sub.2[alpha] (Lutalyse (b)) respectively, immediately after parturition.