vSoothe 2 Vaginal Cream

Cyclobenzaprine

Cyclobenzaprine is a skeletal muscle relaxant approved for the relief of muscle spasm associated with acute, painful musculoskeletal conditions. Cyclobenzaprine is not effective for the treatment of muscle spasm due to central nervous system disease (e.g., cerebral palsy, spinal cord disease). Cyclobenzaprine is very closely related to the antidepressant amitriptyline. Although it is not used clinically as an antidepressant, cyclobenzaprine does possess some pharmacologic effects similar to tricyclic antidepressants. Flexeril® (cyclobenzaprine 10 mg) was first app

Gabapentin is an analog of gamma-aminobutyric acid (GABA) that has GABA agonist activity. Its unique pharmacokinetic properties make it especially useful in certain patients. Gabapentin possesses high lipid solubility, is not metabolized by the liver, has no protein binding, and is devoid of enzyme induction-related drug interactions. Originally developed as an anticonvulsant, gabapentin has been shown to be effective as an adjunct therapy in the treatment of partial seizures with or without secondary generalized tonic-clonic seizures. Efficacy in the treatment of painful neuropathies has also been demonstrated. Investigational uses include monotherapy of refractory partial seizure disorders, treatment of spasticity in multiple sclerosis, and tremor. In addition, gabapentin appears to be effective in reducing hot flashes in menopausal women or women with breast cancer.1

Ketamine

Ketamine is a general anesthetic indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation, for the induction of anesthesia before the administration of other anesthetic agents, and as a supplement to other anesthetic agents.2 It is also used for acute agitation and treatment of acute or chronic pain.345678 Ketamine is unique sedative-hypnotic that produces dissociative anesthesia characterized by potent sedation, amnesia, and analgesia while maintaining cardiovascular stability and preserving spontaneous respiration and protective airway reflexes.23 It is similar in structure, mechanism of action, and activity to phencyclidine (PCP), but ketamine is much less potent and has a shorter duration of action.9 Ketamine has bronchodilatory properties and, in comparison to other sedatives (e.g., opioids, benzodiazepines), offers the advantage of fewer adverse reactions. Hence, ketamine may be an effective alternative to conventional intensive care sedation in certain clinical scenarios (e.g., patients who develop adverse cardiovascular effects with opioids or benzodiazepines, sedation with preservation of spontaneous ventilation, patients with refractory bronchospasm or status asthmaticus).101112 Ketamine is a sympathomimetic; elevations in heart rate and blood pressure are often mild-to-moderate, but it should not be used in patients in whom significant elevations would be deleterious.132 Ketamine anesthesia is notorious for producing a cataleptic state where the eyes remain open with nystagmus; this “disconnected” state may be disconcerting to caregivers and warrants proper caregiver preparation. Other prominent effects of ketamine include excessive airway secretion and emergence reactions. The latter can be managed with short-acting benzodiazepines or barbiturates.

Lidocaine

Lidocaine is a widely used antiarrhythmic and amide-type local anesthetic. As an anesthetic agent, it is available as an ointment, jelly, patch, or aerosol for topical use, as an oral solution, and as an injection. Lidocaine is classified as a class Ib antiarrhythmic. It may be considered for ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) that is unresponsive to cardiopulmonary resuscitation (CPR), defibrillation, and vasopressor therapy. Evidence is inadequate regarding the routine use of lidocaine after cardiac arrest or early (within the first hour) after return of spontaneous circulation (ROSC). However, prophylactic use of lidocaine may be considered in certain circumstances (e.g., during emergency medical services transport) when treatment of recurrent VF/pVT may be challenging.12 Due to the potential for serious adverse reactions, including cardiovascular depression, continuous electrocardiogram monitoring is recommended during intravenous lidocaine treatment.3 There is limited evidence suggesting that nebulized lidocaine exhibits steroid-sparing effects when used in corticosteroid-dependent asthmatics.456 However, extreme caution is recommended until long-term safety and efficacy can be established.