What kind of pill has m357 on it

Hydrocodone and the major metabolites of acetaminophen are known to be substantially excreted by the kidney.

Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Hydrocodone may cause confusion and over-sedation in the elderly; elderly patients generally should be started on low doses of hydrocodone bitartrate and acetaminophen tablets and observed closely.

The most frequently reported adverse reactions are light-headedness, dizziness, sedation, nausea and vomiting. These effects seem to be more prominent in ambulatory than in non-ambulatory patients, and some of these adverse reactions may be alleviated if the patient lies down.

Central Nervous System — Drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dysphoria, psychic dependence, mood changes. Gastrointestinal System — Prolonged administration of hydrocodone bitartrate and acetaminophen tablets may produce constipation.

Genitourinary System — Ureteral spasm, spasm of vesical sphincters and urinary retention have been reported with opiates. Special Senses — Cases of hearing impairment or permanent loss have been reported predominantly in patients with chronic overdose. The following adverse drug events may be borne in mind as potential effects of acetaminophen: allergic reactions, rash, thrombocytopenia, agranulocytosis.

Controlled Substance — Hydrocodone bitartrate and acetaminophen tablets are classified as a Schedule III controlled substance. Abuse and Dependence — Psychic dependence, physical dependence, and tolerance may develop upon repeated administration of narcotics; therefore, this product should be prescribed and administered with caution. However, psychic dependence is unlikely to develop when hydrocodone bitartrate and acetaminophen tablets are used for a short time for the treatment of pain.

Physical dependence, the condition in which continued administration of the drug is required to prevent the appearance of a withdrawal syndrome, assumes clinically significant proportions only after several weeks of continued narcotic use, although some mild degree of physical dependence may develop after a few days of narcotic therapy.

Tolerance, in which increasingly large doses are required in order to produce the same degree of analgesia, is manifested initially by a shortened duration of analgesic effect, and subsequently by decreases in the intensity of analgesia. The rate of development of tolerance varies among patients. Following an acute overdosage, toxicity may result from hydrocodone or acetaminophen. In severe overdosage, apnea, circulatory collapse, cardiac arrest and death may occur.

Acetaminophen — In acetaminophen overdosage: dose-dependent, potentially fatal hepatic necrosis is the most serious adverse effect. Renal tubular necrosis, hypoglycemic coma, and thrombocytopenia may also occur. Early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis and general malaise. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours post-ingestion.

In adults, hepatic toxicity has rarely been reported with acute overdoses of less than 10 grams and fatalities with less than 15 grams. Treatment — A single or multiple overdose with hydrocodone and acetaminophen is a potentially lethal polydrug overdose, and consultation with a regional poison control center is recommended.

Immediate treatment includes support of cardiorespiratory function and measures to reduce drug absorption. Vomiting should be induced mechanically, or with syrup of ipecac, if the patient is alert adequate pharyngeal and laryngeal reflexes. The first dose should be accompanied by an appropriate cathartic.

If repeated doses are used, the cathartic might be included with alternate doses as required. Hypotension is usually hypovolemic and should respond to fluids. Vasopressors and other supportive measures should be employed as indicated. A cuffed endo-tracheal tube should be inserted before gastric lavage of the unconscious patient and, when necessary, to provide assisted respiration. Meticulous attention should be given to maintaining adequate pulmonary ventilation. In severe cases of intoxication, peritoneal dialysis, or preferably hemodialysis may be considered.

If hypoprothrombinemia occurs due to acetaminophen overdose, vitamin K should be administered intravenously. Naloxone, a narcotic antagonist, can reverse respiratory depression and coma associated with opioid overdose. Naloxone hydrochloride 0. Since the duration of action of hydrocodone may exceed that of naloxone, the patient should be kept under continuous surveillance and repeated doses of the antagonist should be administered as needed to maintain adequate respiration. A narcotic antagonist should not be administered in the absence of clinically significant respiratory or cardiovascular depression.

Serum acetaminophen levels should be obtained, since levels four or more hours following ingestion help predict acetaminophen toxicity. Do not await acetaminophen assay results before initiating treatment. Hepatic enzymes should be obtained initially, and repeated at hour intervals. Dosage should be adjusted according to the severity of pain and response of the patient.

The fake pills have the manufacturer's imprint and looks-wise differ only in color from the real pills beige versus white. Her blood tested positive for significant amounts of fentanyl and U, a synthetic opioid, neither of which is an ingredient in brand-name Norco.

From March to April, , 12 fentanyl-related fatalities and 40 additional cases of toxicity were reported in Sacramento and Yolo counties in North California due to fake Norco pills containing fentanyl. Additional cases were identified in the San Francisco area. Many novel psychoactive substances are produced in China, then enter the U. Since more than psychoactive substances, including six fentanyl analogs, were banned by China in , novel synthetic opioids such as U and W have entered the market, replacing more established and outlawed drugs.

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