scholarly journals Clinical pharmacology and therapeutics

2016 ◽  
Keyword(s):  
Clinical Pharmacology ◽  
Carbon Monoxide Poisoning ◽  
Tricyclic Antidepressant ◽  
Lithium Toxicity ◽  
Basic Training ◽  
Paracetamol Poisoning ◽  
Drug Reactions ◽  
Ethylene Glycol Poisoning ◽  
Salicylate Poisoning ◽  
Special Circumstances

Chapter 5 covers the basic science and clinical topics relating to clinical pharmacology and therapeutics which trainees are required to learn as part of their basic training and demonstrate in the MRCP. It covers pharmacodynamics, pharmacokinetics, drug metabolism and prescribing in special circumstances, drug interactions, adverse drug reactions, drug development, paracetamol poisoning, salicylate poisoning, lithium toxicity, digoxin toxicity, carbon monoxide poisoning, ethylene glycol poisoning, and tricyclic antidepressant poisoning.

Toxicology

2013 ◽  
Author(s):  
Victoria Stacey
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Tricyclic Antidepressant ◽  
Paracetamol Poisoning ◽  
Salicylate Poisoning

Introduction - General principles of poisoning management - Toxidromes - Paracetamol poisoning - Salicylate poisoning - Tricyclic antidepressant poisoning - Carbon monoxide poisoning - SAQs

Toxicology

2012 ◽  
pp. 179-218
Author(s):  
Jonathan P. Wyatt ◽  
Robin N. Illingworth ◽  
Colin A. Graham ◽  
Kerstin Hogg ◽  
Michael J. Clancy ◽  
...  
Keyword(s):  
Supportive Care ◽  
Tricyclic Antidepressant ◽  
Paracetamol Poisoning ◽  
Barbiturate Poisoning ◽  
Salicylate Poisoning

Poisons: general principles 180 Diagnosis of poisoning 182 Poisons: supportive care 183 Reducing absorption of poison 184 Antidotes for poisons 186 Opioid poisoning 188 Salicylate poisoning 189 Paracetamol poisoning 190 Tricyclic antidepressant poisoning 194 Benzodiazepine poisoning 196 Clomethiazole poisoning 196 Phenothiazine poisoning 196 Barbiturate poisoning ...

Emergencies

2017 ◽  
pp. 778-851
Author(s):  
Ian B. Wilkinson ◽  
Tim Raine ◽  
Kate Wiles ◽  
Anna Goodhart ◽  
Catriona Hall ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Tension Pneumothorax ◽  
Acute Poisoning ◽  
Paracetamol Poisoning ◽  
Coronary Syndrome ◽  
Salicylate Poisoning ◽  
Acute Exacerbations ◽  
St Elevation ◽  
Broad Complex ◽  
Narrow Complex Tachycardia

This chapter explores cardiovascular, respiratory, gastrointestinal, neurological, and endocrinological emergencies, including headache, breathlessness, chest pain, coma, Glasgow Coma Scale (GCS), shock, sepsis, anaphylactic shock, acute coronary syndrome with ST-elevation, acute coronary syndrome without ST-elevation, severe pulmonary oedema, cardiogenic shock, broad complex tachycardia, narrow complex tachycardia, bradycardia, acute severe asthma, acute exacerbations of COPD, pneumothorax, tension pneumothorax, pneumonia, pulmonary embolism (PE), acute upper GI bleeding, meningitis, encephalitis, cerebral abscess, status epilepticus, head injury, raised intracranial pressure (ICP), diabetic ketoacidosis (DKA), diabetic emergencies, thyroid emergencies, Addisonian crisis, hypopituitary coma, phaeochromocytoma emergencies, acute poisoning, poisons and their antidotes, paracetamol poisoning, salicylate poisoning, burns, hypothermia, and major disasters

scholarly journals Evaluation of Spontaneous Statements of Adverse Drug Reactions: Our Clinical Pharmacology Experience

2019 ◽  
Vol 8 (2) ◽  
pp. 230-239
Author(s):  
Duygun Altıntaş Aykan ◽  
Hülya Nazik ◽  
Yusuf Ergün
Keyword(s):  
Clinical Pharmacology ◽  
Adverse Drug Reactions ◽  
Drug Reactions

scholarly journals An opportunity for clinical pharmacology trained physicians to improve patient drug safety: A retrospective analysis of adverse drug reactions in teenagers

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 677 ◽  
Author(s):  
Andy R. Eugene ◽  
Beata Eugene
Keyword(s):  
Clinical Pharmacology ◽  
Drug Interactions ◽  
Adverse Drug Reactions ◽  
Hospital Admissions ◽  
The United States ◽  
Drug Reactions ◽  
The Third ◽  
Data Limitations ◽  
Ondansetron Hydrochloride ◽  
Improve Patient

Background: Adverse drug reactions (ADRs) are a major cause of hospital admissions, prolonged hospital stays, morbidity, and drug-related mortality. In this study, we sought to identify the most frequently reported medications and associated side effects in adolescent-aged patients in an effort to prioritize clinical pharmacology consultation efforts for hospitals seeking to improve patient safety.   Methods: Quarterly reported data were obtained from the United States Food and Drug Administration Adverse Events Reporting System (FAERS) from the third quarter of 2014 and ending in the third quarter of 2017. We then used the GeneCards database to map the pharmacogenomic biomarkers associated with the most reported FAERS drugs. Data homogenization and statistics analysis were all conducted in R for statistical programming. Results: We identified risperidone (10.64%) as the compound with the most reported ADRs from all reported cases. Males represented 90.1% of reported risperidone cases with gynecomastia being the most reported ADR. Ibuprofen OR=188 (95% CI, 105.00 – 335.00) and quetiapine fumarate OR=116 (95% CI, 48.40 – 278.00) were associated with the highest odds of completed suicide in teenagers. Ondansetron hydrochloride OR=7.12 (95% CI, 1.59 – 31.9) resulted in the highest odds of pneumothorax. Lastly, olanzapine (8.96%) represented the compound with the most reported drug-drug interactions cases, while valproic acid OR=221 (95% CI, 93.900 – 522.00) was associated with the highest odds of drug-drug interactions. Conclusion: Despite any data limitations, physicians prescribing risperidone in males should be aware of the high rates of adverse drug events and an alternative psychotropic should be considered in male patients. Further, patients with a history of pneumothorax or genetically predisposed to pneumothorax should be considered for an alternative antiemetic to ondansetron hydrochloride, due to increased odds associated with the drug and adverse event.

Role of toxicology assessment in poisoning

2016 ◽  
Author(s):  
Albert Jaeger
Keyword(s):  
Ethylene Glycol ◽  
Parent Compound ◽  
Kinetic Studies ◽  
Acute Poisoning ◽  
Ethylene Glycol Poisoning ◽  
Salicylate Poisoning ◽  
Theophylline Poisoning ◽  
Quantitative Analyses ◽  
Toxicology Assessment

Diagnosis of acute poisoning is based on history, symptoms, biomedical investigations, toxicological analyses, and sometimes therapeutic tests. Toxicological analytical methods are now widely available. A qualitative or semiquantitative analysis of the parent compound may be adequate for diagnostic assessment. A quantitative analysis is mandatory for kinetic studies. For instance, in ethylene glycol poisoning, analysis of ethylene glycol concentrations is useful for the diagnosis, but glycolate concentrations are more relevant for the evaluation of the severity and prognosis. Groups of symptoms (or toxidromes) may provide diagnostic clues for toxins that are not usually included in routine screening. The management of the poisoned patient is mostly supportive, but toxicological quantitative analyses are mandatory for some treatments, e.g. alkaline diuresis in salicylate poisoning, repeated activated charcoal in theophylline poisoning, haemodialysis, ethanol in ethylene glycol poisoning, or the use of chelating agents.

Clinical Pharmacology

2020 ◽  
Author(s):  
Molly Droege ◽  
Eric W. Mueller
Keyword(s):  
Clinical Pharmacology ◽  
Critically Ill ◽  
Adverse Drug Reactions ◽  
Therapeutic Interventions ◽  
Surgical Patients ◽  
Therapeutic Drug ◽  
Drug Reactions ◽  
Organ Function ◽  
Key Factor ◽  
Critically Ill Surgical Patients

Critically ill patients often require surgical procedures and therapeutic interventions that produce significant pathophysiologic changes. Drug pharmacology can be greatly altered in this population wherein comorbid diseases, varied organ function, and polypharmacy can produce adverse drug reactions (ADRs). This review aims to describe basic pharmacokinetic principles (absorption, distribution, metabolism, elimination) and changes in these processes due to altered organ function in critically ill surgical patients. This knowledge is a key factor in reducing ADRs. This review contains 10 figures, 2 tables, 101 references Keywords: adverse drug reactions, drug interactions, obesity, pharmacodynamics, pharmacokinetics, plasma protein binding, therapeutic drug monitoring  

Clinical Pharmacology

2020 ◽  
Author(s):  
Molly Droege ◽  
Eric W. Mueller
Keyword(s):  
Clinical Pharmacology ◽  
Critically Ill ◽  
Adverse Drug Reactions ◽  
Therapeutic Interventions ◽  
Surgical Patients ◽  
Therapeutic Drug ◽  
Drug Reactions ◽  
Organ Function ◽  
Key Factor ◽  
Critically Ill Surgical Patients

Critically ill patients often require surgical procedures and therapeutic interventions that produce significant pathophysiologic changes. Drug pharmacology can be greatly altered in this population wherein comorbid diseases, varied organ function, and polypharmacy can produce adverse drug reactions (ADRs). This review aims to describe basic pharmacokinetic principles (absorption, distribution, metabolism, elimination) and changes in these processes due to altered organ function in critically ill surgical patients. This knowledge is a key factor in reducing ADRs. This review contains 10 figures, 2 tables, 101 references Keywords: adverse drug reactions, drug interactions, obesity, pharmacodynamics, pharmacokinetics, plasma protein binding, therapeutic drug monitoring  

scholarly journals How Safe is Intravenous N-Acetylcysteine for the Treatment of Paracetamol Poisoning?

2007 ◽  
Vol 14 (4) ◽  
pp. 198-203 ◽  
Author(s):  
W Merl ◽  
Z Koutsogiannis ◽  
D Kerr ◽  
AM Kelly
Keyword(s):  
Adverse Drug Reactions ◽  
Univariate Analysis ◽  
Primary Outcome Measure ◽  
Paracetamol Poisoning ◽  
Drug Reactions ◽  
Chi Square ◽  
Exact Test ◽  
Clinically Significant ◽  
Paracetamol Toxicity ◽  
Chi Square Analysis

Objective Paracetamol poisoning remains one of the most common and potentially lethal ingestions. N-acetylcysteine (NAC) has been proven to be a highly effective antidote. The aim of this study was to determine the rate of adverse drug reactions (ADR) to intravenous (IV) NAC. Our hypothesis was that IV NAC for the treatment of paracetamol toxicity has a low rate of adverse events. Methods This was an observational cohort study undertaken by explicit retrospective medical record review. It included patients who presented to the emergency department with paracetamol overdose over the ten-year period from July 1995 to June 2004. The primary outcome measure was the occurrence of an ADR during NAC administration. Adverse drug reactions were classified as minor (including flushing, urticaria, pruritus, bronchospasm, tachycardia, and non-ischaemic chest pain) and major (including hypotension, angio-oedema and death). Data analysis was by descriptive statistics and chi-square analysis using univariate analysis, Fisher's exact test and Mann-Whitney U-test. Inter-rater agreement was checked for 9% of the sample. Results There were 470 cases of paracetamol poisoning. Of these, 320 received IV NAC. Thirty-six (11%, 95% CI 8–15%) of these patients developed ADRs. There were two major ADRs, one hypotension and one angio-oedema (0.6%, 95% CI 0.02–2%). Two patients died during hospitalisation, but neither had an ADR to NAC. The most common ADRs were urticaria (20), flushing (15), bronchospasm (12), and pruritus (3). None of the variables analysed was a clinically significant predictor of increased ADR risk. Conclusion Adverse drug reactions after IV NAC infusion occur commonly, but most are minor. Treatment of paracetamol poisoning with IV NAC appears to be safe, however a large prospective study would be required to confirm this.

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