Psychoactives in Experience by Prescription

Psychoactives in Experience by Prescription
(Alphabetically by Category and Substance)

Opioids:
Buprenorphine (Suboxone, active metabolite Norbuprenorphine; stronger Mu agonist and full nociceptin agonist)
Butorphanol
Codeine Phosphate
***Dextromethorphan (aka DXM, Dextro-Methyl-Ethyl enantiomer Levorphanol / stereoisomer Levomethorphan)
***Dextrorphan (aka DXO, active NMDA antagonist metabolite of Dextromethorphan – strong NMDA antagonist)
***NOTE: DXM / DXO are *not* opioid analgesics; have been shown to increase opioid analgesic effect & are NMDA antagonists)
Diphenoxylate
Hydrocodone
Meperidine
Methadone
Oxycodone
Propoxyphene
Tramadol


Opioid Antagonists:
Naloxone (Low-zero bioavailability due to sublingual administration with Buprenorphine [Suboxone])


Sedatives/Hypnotics:
Alprazolam [BZP]
Carisoprodol (skeletal muscle relaxant, active metabolite Meprobamate)
Clonazepam [BZP]
Clorazepate [BZP]
Diazepam [BZP]
Lorazepam [BZP]
Midazolam [BZP]
Nitrazepam [BZP]
Oxazepam [BZP]
Promethazine (sedative antihistamine)
Propofol (IV anesthetic; lipid)
Temazepam [BZP]
Triazolam [BZP]
Zolpidem [Non-BZP Hypnotic}


Stimulants:
Amphetamine Salts (Adderall IR)
Methylphenidate ER (Ritalin)
Methylphenidate LA (Concerta)

Syringe/Needle vs. Syringe/WingedVacutainer IV Set

I've decided that as a phlebotomist and medication administrator, I strongly prefer Vacutainer/Angel Wing/Butterfly tubing with a winged needle set compared to a direct blood draw/medication administration with a standard syringe/needle (standard luer lock) directly connected. The winged administration/collection set is much easier to handle, safer, and can be taped with Transpore, paper tape, or similar to secure in place once venipuncture is obtained making the administration or draw far less prone to a missed access attempt (or extravasation during administration) and much more stable during the process of the procedure. This is especially important in avoiding care provider needle sticks (due to the tubing and needle not being directly attached to the syringe/collection vial; non flexible syringe/collection vial/needle sets can easily lead to an accidental needle stick if the patient flinches, moves, is uncooperative, etc). Once venous access is obtained, the hazard of a direct syringe/needle stick is almost negated by the remote needle attached to the tube, which is then attached to the collection vial or syringe.

This is of course all assuming the patient does not have current patent IV access via a saline/hep lock or continuous infusion line with a Y site allowing administration through the infusion line. It is also helpful when an infusion line is delivering an incompatible medication with a new medication ordered for a single administration, or when a fresh blood draw is needed and can not be obtained via an infusion line or lock (which is most often the case).

This is not news to most phlebotomists as winged collection sets are considered standard procedure by many. It is however a consideration for IV access intended for medication administration on an infrequent basis or single administration. In these cases, more often a syringe/needle is used to acquire venous access and the risk of accidental needle stick is greater. It is these types of situations where a winged infusion/collection set with tubing might be considered a safer alternative in my opinion...

IF YOU SUSTAIN A NEEDLE STICK, FOLLOW THESE STEPS AT ONCE:

1. Discontinue patient treatment immediately
2. Wash affected area with soap and water thoroughly without delay
   
3. If Chlorhexidine or a comparable antiseptic is available, use as directed
4. Report exposure to supervisory personnel without delay
5. See Occupational Health in less than two hours for further treatment

And of course, ALWAYS use *Universal Precautions* when potentially interacting with ALL patients, regardless of whether or not there will be expected exposure to bodily fluids. For a more extensive listing of Universal Precautions and Isolation Techniques (Barrier Gowns, Masks, Face and Eye Shields, Gloves, etc) see Wikipedia: Universal Precautions.