Inj Norad Lori Ephepress Teramin Levetiracetam Sugammadex , classes,uses, mechanism of action
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sugammadex AND anesthesia
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Lori injection brand composition Teramin injection brand composition Ephepress injection composition
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"Teramin injection" composition uses
Assuming the brand names refer to the following commonly used injections. Please verify the vial label, since brand names can differ by country/manufacturer.
| Injection | Generic drug | Class | Main uses | Mechanism of action |
|---|---|---|---|---|
| Norad | Noradrenaline / norepinephrine | Sympathomimetic catecholamine vasopressor, mainly alpha-1 agonist | First-line vasopressor in septic shock; severe acute hypotension, including during anesthesia | Predominantly stimulates alpha-1 receptors causing arterial and venous vasoconstriction, increasing systemic vascular resistance and blood pressure. Some beta-1 stimulation increases cardiac contractility. |
| Lori | Diazepam | Benzodiazepine | Acute seizures/status epilepticus, anxiety, alcohol withdrawal, muscle spasm, procedural sedation | Positive allosteric modulator of GABA-A receptors. It increases the frequency of chloride-channel opening, causing neuronal inhibition. |
| Ephepress | Likely ephedrine | Mixed-acting sympathomimetic vasopressor | Short-term treatment of hypotension, especially hypotension after spinal or general anesthesia | Directly stimulates alpha and beta adrenergic receptors and indirectly releases stored norepinephrine from sympathetic nerve terminals. Raises heart rate, cardiac output, and blood pressure. Repeated use can cause tachyphylaxis because norepinephrine stores become depleted. |
| Teramin | Likely mephentermine (often marketed as Termin) | Indirect sympathomimetic vasopressor | Hypotension, particularly after spinal anesthesia | Releases norepinephrine from adrenergic nerve endings, producing vasoconstriction and cardiac stimulation, thereby increasing blood pressure. |
| Levetiracetam | Levetiracetam | Antiseizure medication | Focal-onset seizures, generalized tonic-clonic seizures, myoclonic seizures; IV use when oral treatment is not possible | Binds SV2A, a synaptic-vesicle protein, and modulates neurotransmitter release to reduce abnormal neuronal firing. Its exact antiseizure mechanism is not fully defined. |
| Sugammadex | Sugammadex | Selective relaxant-binding agent, modified gamma-cyclodextrin | Rapid reversal of neuromuscular blockade caused by rocuronium or vecuronium after general anesthesia | Encapsulates free rocuronium or vecuronium molecules in plasma. This lowers the free drug concentration, pulling relaxant away from the neuromuscular junction and reversing paralysis. It does not work by inhibiting acetylcholinesterase. |
High-yield differences
- Noradrenaline: direct vasopressor, mainly alpha-1 effect. Preferred for septic shock.
- Ephedrine and mephentermine: indirect or mixed sympathomimetics. They can cause tachycardia and are less predictable after repeated administration.
- Diazepam: sedative-anticonvulsant. Main acute risks are respiratory depression, excessive sedation, and hypotension, especially with opioids or other sedatives.
- Levetiracetam: little hepatic enzyme interaction, but can cause somnolence, dizziness, irritability, agitation, mood changes, and rarely suicidal thoughts.
- Sugammadex: only reverses aminosteroid muscle relaxants, especially rocuronium and vecuronium. Important concerns include bradycardia, hypersensitivity/anaphylaxis, and reduced reliability of hormonal contraception for 7 days after a dose. It is generally avoided or used very cautiously in severe renal impairment because the drug-relaxant complex is renally excreted.
The pharmacology descriptions of ephedrine and sugammadex align with Barash, Cullen, and Stoelting’s Clinical Anesthesia, 9e and Miller’s Anesthesia, 10e. Recent evidence also supports sugammadex’s role in improving recovery from neuromuscular blockade, although adverse-effect outcomes depend on the population studied (2024 systematic review, PMID 38036323).
For the likely brand interpretations: Lori injection is listed as diazepam, while Termin 30 mg is listed as mephentermine.
Difference between bradycardia and tachycardia
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bradycardia AND tachycardia
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American Heart Association adult bradycardia tachycardia heart rate definitions
| Feature | Bradycardia | Tachycardia |
|---|---|---|
| Meaning | Heart rate that is too slow | Heart rate that is too fast |
| Adult resting rate | Usually <60 beats/min. In acute-care algorithms, clinically significant bradycardia is often considered <50/min. | Usually >100 beats/min |
| Effect on cardiac output | May lower cardiac output because the heart beats too infrequently | May lower cardiac output because there is inadequate time for ventricular filling at very fast rates |
| Common causes | Sleep, athletic training, vagal stimulation, hypothermia, hypothyroidism, drugs such as beta-blockers, heart block/sinus-node disease | Exercise, anxiety, pain, fever, dehydration, anemia, hypoxia, hyperthyroidism, stimulants, shock, arrhythmias |
| Symptoms if significant | Fatigue, dizziness, syncope, hypotension, altered sensorium, chest discomfort | Palpitations, dizziness, breathlessness, chest discomfort, hypotension, syncope |
| Examples | Sinus bradycardia, AV block | Sinus tachycardia, SVT, atrial fibrillation with rapid ventricular response, ventricular tachycardia |
Normal adult resting heart rate: about 60 to 100/min.
A slow rate can be normal during sleep or in trained athletes. A fast rate can be normal with exercise, fever, pain, or anxiety. The concern is not only the number, but whether the patient has poor perfusion or symptoms.
Seek urgent assessment for either slow or fast pulse with fainting, chest pain, severe breathlessness, confusion, shock, or persistent very low/high blood pressure. The American Heart Association guidance identifies hypotension, altered mental status, ischemic chest discomfort, acute heart failure, and syncope as signs of clinically important bradycardia.
In which case blood pressure gets low
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hypotension AND diagnosis
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Merck Manual causes of low blood pressure hypotension dehydration bleeding sepsis heart problems
Blood pressure gets low when one or more of these happen:
-
Low blood volume
- Dehydration from vomiting, diarrhea, fever, poor fluid intake
- Blood loss from trauma, surgery, gastrointestinal bleeding, heavy menstrual/postpartum bleeding
- Burns or severe fluid loss
-
Blood vessels become too dilated
- Spinal or epidural anesthesia can block sympathetic nerves and cause vasodilation
- Severe infection: sepsis/septic shock
- Severe allergy: anaphylaxis
- Some medicines, including anesthetic drugs, antihypertensives, nitrates, and sedatives
-
Heart pumps inadequately
- Heart attack, severe heart failure
- Very slow heart rate (bradycardia)
- Very fast abnormal rhythm, such as SVT or ventricular tachycardia
- Severe valve disease
-
Blood flow is obstructed
- Pulmonary embolism
- Cardiac tamponade
- Tension pneumothorax
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On standing up
- Orthostatic/postural hypotension, often due to dehydration, blood-pressure drugs, autonomic dysfunction, or prolonged bed rest.
In the operation theatre, low BP is particularly common after spinal anesthesia, due to sympathetic blockade causing vasodilation. This is why drugs such as ephedrine, mephentermine, phenylephrine, or noradrenaline may be used by the anesthesia team depending on heart rate and clinical situation.
Urgent evaluation is needed if low BP is associated with fainting, confusion, chest pain, breathlessness, cold clammy skin, very low urine output, or active bleeding. Merck’s low-BP overview summarizes dehydration, blood loss, heart problems, infection, allergy, and medicines as major causes.
Low BP in which case bradycardia or tachycardia
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hypotension AND bradycardia
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bradycardia versus tachycardia hypotension causes anesthesia physiology
In low blood pressure, the heart rate may be either fast (tachycardia) or slow (bradycardia). It depends on the cause.
| Low BP with tachycardia | Low BP with bradycardia |
|---|---|
| Most common compensatory response. The body increases heart rate to maintain cardiac output. | Usually suggests vagal stimulation, conduction problem, or loss of sympathetic activity. |
| Causes: bleeding, dehydration, sepsis, fever, pain, anxiety, anaphylaxis, early shock. | Causes: high spinal anesthesia, vasovagal episode, severe hypoxia, heart block, inferior-wall MI, beta-blockers, calcium-channel blockers, opioids, dexmedetomidine. |
| Example: BP 80/50 with pulse 120/min after bleeding or dehydration. | Example: BP 80/50 with pulse 40/min after high spinal block or vagal reaction. |
| Treat the underlying cause, give fluids/blood if needed, and use vasopressor if appropriate. | Correct cause. If symptomatic/unstable, atropine and pacing or vasoactive support may be needed under medical supervision. |
Simple rule
-
Low BP + fast pulse: think volume loss or shock.
Examples: bleeding, dehydration, sepsis. -
Low BP + slow pulse: think spinal anesthesia, vagal reaction, heart block, or medication effect.
In spinal anesthesia
- Usually, sympathetic blockade causes low BP.
- If the block is high or venous return falls significantly, it may also cause bradycardia.
- If BP is low but HR is fast, ephedrine may be useful because it raises both HR and BP.
- If BP is low with a normal/high HR, a predominantly vasoconstrictor drug such as phenylephrine or noradrenaline may be selected depending on the clinical setting.
- Low BP with marked bradycardia needs urgent assessment, often including atropine and correction of the block-related/other cause.
Urgent treatment is required if low BP occurs with altered consciousness, chest pain, breathlessness, cold clammy skin, fainting, or poor urine output.
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