Anticholinergic Toxicity

2016 ◽  
Author(s):  
Jeffrey T Lai ◽  
Kavita M Babu
Keyword(s):  
Prescription Medication ◽  
Tricyclic Antidepressant ◽  
Over The Counter ◽  
Anticholinergic Activity ◽  
Anticholinergic Medications ◽  
Tricyclic Antidepressant Overdose ◽  
Wide Range ◽  
Definitive Therapy ◽  
Electrocardiographic Changes ◽  
Seasonal Allergies

Anticholinergic compounds oppose the action of the endogenous neurotransmitter acetylcholine at its target receptors and are found in over-the-counter and prescription medication, natural products, and plants. Anticholinergic medications, such as atropine and scopolamine, are used for the treatment of a wide range of conditions, including bradycardia, motion sickness, and insomnia. Antihistaminergic medications, such as diphenhydramine, also possess anticholinergic activity and are used in the treatment of seasonal allergies, common cold symptoms, and allergic reactions. Other medications, such as antidepressants (especially the older tricyclic class), antipsychotics, muscle relaxants, and anticonvulsants, can act as anticholinergic agents or produce anticholinergic side effects. Toxicity can result from therapeutic misadventure, intentional overdose, recreational use, and pediatric exposures. This review covers the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes. Figures show the anticholinergic toxidrome, look-alike structures, and electrocardiographic changes in tricyclic antidepressant overdose. Tables list medications with anticholinergic activity and selected botanicals that cause anticholinergic toxicity. Key words: anticholinergic overdose, anticholinergic toxicity, anticholinergic toxidrome, physostigmine, tricyclic antidepressant toxicity This review contains 3 highly rendered figures, 2 tables, and 49 references.

Anticholinergic Toxicity

2016 ◽  
Author(s):  
Jeffrey T Lai ◽  
Kavita M Babu
Keyword(s):  
Prescription Medication ◽  
Tricyclic Antidepressant ◽  
Over The Counter ◽  
Anticholinergic Activity ◽  
Anticholinergic Medications ◽  
Tricyclic Antidepressant Overdose ◽  
Wide Range ◽  
Definitive Therapy ◽  
Electrocardiographic Changes ◽  
Seasonal Allergies

Anticholinergic compounds oppose the action of the endogenous neurotransmitter acetylcholine at its target receptors and are found in over-the-counter and prescription medication, natural products, and plants. Anticholinergic medications, such as atropine and scopolamine, are used for the treatment of a wide range of conditions, including bradycardia, motion sickness, and insomnia. Antihistaminergic medications, such as diphenhydramine, also possess anticholinergic activity and are used in the treatment of seasonal allergies, common cold symptoms, and allergic reactions. Other medications, such as antidepressants (especially the older tricyclic class), antipsychotics, muscle relaxants, and anticonvulsants, can act as anticholinergic agents or produce anticholinergic side effects. Toxicity can result from therapeutic misadventure, intentional overdose, recreational use, and pediatric exposures. This review covers the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes. Figures show the anticholinergic toxidrome, look-alike structures, and electrocardiographic changes in tricyclic antidepressant overdose. Tables list medications with anticholinergic activity and selected botanicals that cause anticholinergic toxicity. Key words: anticholinergic overdose, anticholinergic toxicity, anticholinergic toxidrome, physostigmine, tricyclic antidepressant toxicity This review contains 3 highly rendered figures, 2 tables, and 49 references.

Cardiotoxic Side Effects Associated with Tricyclic Antidepressant Overdose

1992 ◽  
Vol 3 (1) ◽  
pp. 226-232 ◽  
Author(s):  
Nancy A. Keis
Keyword(s):  
Patient Outcomes ◽  
Tricyclic Antidepressants ◽  
Fatal Outcome ◽  
Severe Depression ◽  
Tricyclic Antidepressant ◽  
Nursing Interventions ◽  
Cardiac Symptoms ◽  
Tricyclic Antidepressant Overdose ◽  
Electrocardiographic Changes ◽  
Effective Medication

Tricyclic antidepressants (TCAs) arc a popular, effective medication prescribed for patients with depression. The patient with severe depression may exhibit suicidal tendencies; thus, overdose of a prescribed TCA may occur, resulting in a potentially fatal outcome. The cardiotoxic effect of TCA overdose is the most pronounced complication. Multiple rhythm disturbances may occur in the presence of a TCA overdose. The greatest number of adverse cardiac symptoms and electrocardiographic changes are likely to occur within the first 24 hours after overdose. Nursing care of the patient with a TCA overdose is based upon ongoing patient assessment, identification of problems and potential problems, establishment of expected patient outcomes, and specific nursing interventions

090 Strategies for Dealing with or Ameliorating Excessive Sleepiness: Beliefs and Attitudes of People with Daytime Sleepiness

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A37-A38
Author(s):  
Breanna Featherston ◽  
Ashna Kapoor ◽  
Chloe Wills ◽  
Andrew Tubbs ◽  
Michael Grandner
Keyword(s):  
Daytime Sleepiness ◽  
Sleep Problems ◽  
Stimulant Medication ◽  
Prescription Medication ◽  
Relaxation Techniques ◽  
Over The Counter ◽  
Breathing Exercises ◽  
Wide Range ◽  
Counter Medication ◽  
Beliefs And Attitudes

Abstract Introduction Sleepiness impacts health and functioning, but despite available treatments, many do not seek care. Beliefs and attitudes about treatments for sleepiness and other sleep problems may be useful to know in designing and targeting interventions. Methods N=28 participants with excessive daytime sleepiness (ESS>=10) but no other major medical problems were recruited from the community. They were administered an Epworth Sleepiness Scale and Fatigue Severity Scale at baseline, and asked about a wide range of beliefs/attitudes about mitigating sleepiness, and whether they Strongly Agree(SA), Agree(A), Disagree(D), or Strongly Disagree(SD) with them. Ordinal logistic regressions examined agreement associated with baseline sleepiness and fatigue, adjusted for age, sex, and race/ethnicity (nominal significance p<0.05). Results When asked which strategies are helpful for dealing with or fixing daytime sleepiness, baseline agreement was as follows: Just “power through it” (SA:9%,A:55%,D:32%,SD:5%). Caffeine (SA:18%,A:55%,D:27%). Vigorous exercise (SA:9%,A:36%,D:55%). Mild or moderate movement or exercise (SA:14%,A:82%,D:5%). Trying to get better sleep at night (SA:36%,A:64%). Eating or drinking something to help “wake you up” (SA:27%,A:45%,D:23%,SD:5%). Napping (SA:27%,A:64%,D:9%). Giving up and letting yourself be sleepy (SA:9%,A:42%,D:45%,SD:5%). Improve your diet/eat healthy (SA:42%,A:55%,D:5%). Relaxing activities at night (SA:27%,A:68%,D:5%). Meditation, breathing exercises, or other relaxation techniques (SA:45%,A:45%,D:9%). Watching TV, browsing the internet, or other distracting activities (SA:5%,A:36%,D:45%,SD:14%). Just keep moving (SA:9%,A:55%,D:42%,SD:5%). Setting alarms (SA:18%,A:68%,D:14%). Take prescription medication to improve sleep (SA:5%,A:27%,D:42%,SD:27%). Take over-the-counter medication to improve sleep (SA:5%,A:27%,D:59%,SD:9%). Take prescription stimulant medication (SA:5%,A:32%,D:45%,SD:18). Take over-the-counter stimulant medication (SA:5%,A:27%,D:55%,SD:14%). Take prescription medication that reduces daytime sleepiness (SA:5%,A:36%,D:41%,SD:18%). Take over-the-counter medication that reduces daytime sleepiness (SA:5%,A:27%,D:50%,SD:18%). Those with higher levels of baseline sleepiness were more likely to endorse the following as good strategies to handle daytime sleepiness, “Take over-the-counter medication to improve sleep” (oOR=1.55, p=0.04), “Take prescription medication to improve sleep” (oOR=1.49, p=0.01), and “napping” (oOR=2.55, p=0.03). Those with higher baseline fatigue were less likely to endorse “just ‘powering_through’” (oOR=0.81, p=0.02) as a good strategy of handling daytime sleepiness. Conclusion Real-world beliefs and attitudes about ways of mitigating effects of sleepiness range from medical to behavioral. Those with greater baseline sleepiness may be more amenable to medication. Support (if any) This work was supported by Jazz Pharmaceuticals

373 Historical Use of Substances for Insomnia Impacts Current Beliefs about Hypnotic Medications

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A148-A149
Author(s):  
Jessica Dietch ◽  
Norah Simpson ◽  
Joshua Tutek ◽  
Isabelle Tully ◽  
Elizabeth Rangel ◽  
...  
Keyword(s):  
Prescription Medication ◽  
Stepped Care ◽  
Future Research ◽  
Prescription Medications ◽  
Over The Counter ◽  
Multiple Treatment ◽  
History Of ◽  
Study Participants ◽  
Beliefs About Medications ◽  
The Impact

Abstract Introduction The purpose of the current study was to examine the relationship between current beliefs about hypnotic medications and historical use of prescription hypnotic medications or non-prescription substances for sleep (i.e., over the counter [OTC] medications, alcohol, and cannabis). Methods Participants were 142 middle age and older adults with insomnia (M age = 62.9 [SD = 8.1]; 71.1% female) enrolled in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study. Participants reported on history of substances they have tried for insomnia and completed the Beliefs about Medications Questionnaire-Specific with two subscales assessing beliefs about 1) the necessity for hypnotics, and 2) concerns about potential adverse consequences of hypnotics. Participants were grouped based on whether they had used no substances for sleep (No Subs, 11.6%), only prescription medications (Rx Only, 9.5%), only non-prescription substances (NonRx Only, 26.6%), or both prescription and non-prescription substances (Both, 52.3%). Results Sixty-one percent of the sample had used prescription medication for sleep and 79% had used non-prescription substances (74% OTC medication, 23% alcohol, 34% cannabis). The greater number of historical substances endorsed, the stronger the beliefs about necessity of hypnotics, F(1,140)=23.3, p<.001, but not about concerns. Substance groups differed significantly on necessity beliefs, F(3,1)=10.68, p<.001; post-hocs revealed the Both group had stronger beliefs than the No and NonRx Only groups. Substance groups also differed significantly on the concerns subscale, F(3,1)=6.68, p<.001; post-hocs revealed the NonRx Only group had stronger harm beliefs than the other three groups. Conclusion The majority of the sample had used both prescription and non-prescription substances to treat insomnia. Historical use of substances for treating insomnia was associated with current beliefs about hypnotics. Individuals who had used both prescription and non-prescription substances for sleep in the past had stronger beliefs about needing hypnotics to sleep at present, which may reflect a pattern of multiple treatment failures. Individuals who had only tried non-prescription substances for sleep may have specifically sought alternative substances due to concerns about using hypnotics. Future research should seek to understand the impact of treatment history on engagement in and benefit from non-medication-based treatment for insomnia. Support (if any) 1R01AG057500; 2T32MH019938-26A1

scholarly journals Understanding older adults' medication decision making and behavior: A study on over-the-counter (OTC) anticholinergic medications

2019 ◽  
Vol 15 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Richard J. Holden ◽  
Preethi Srinivas ◽  
Noll L. Campbell ◽  
Daniel O. Clark ◽  
Kunal S. Bodke ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Over The Counter ◽  
Anticholinergic Medications ◽  
And Behavior

scholarly journals How the Lifestyle Leaders View and Manage Medications

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 611-612
Author(s):  
Taylor Patskanick ◽  
Julie Miller
Keyword(s):  
Side Effects ◽  
Medication Management ◽  
Healthcare Providers ◽  
Prescription Medication ◽  
The Internet ◽  
Prescription Medications ◽  
Over The Counter ◽  
Attitudes And Behaviors ◽  
The Past ◽  
Drug Companies

Abstract Medication management is an ongoing consideration for adults ages 85 and older, their caregivers, and healthcare providers. When asked about their attitudes and behaviors regarding medication management, over 73% of the Lifestyle Leaders reported taking 3+ prescription medications daily and managing their own medication regimes. 61.9% of participants had taken over-the-counter, non-prescription medication for pain over the past five years. When asked why some participants didn’t currently take prescription medications to manage pain, the most frequently-reported responses were: “I don’t feel that my pain warrants a prescription medication,” (19%, n=8), “I don’t want to deal with the side effects,” and “I don’t trust drug companies,” (9.5%, n=4, respectively). The Lifestyle Leaders reported they would be most likely to go to the internet (over their local pharmacist) to ask for advice about their medication(s). Meanwhile, 39% of Lifestyle Leaders would trust a robot to manage their medication(s) for them.

RYR1-related rhabdomyolysis: a spectrum of hypermetabolic states due to ryanodine receptor dysfunction

2021 ◽  
Vol 27 ◽  
Author(s):  
Nick Kruijt ◽  
Luuk Van den Bersselaar ◽  
Marc Snoeck ◽  
Kees Kramers ◽  
Sheila Riazi ◽  
...  
Keyword(s):  
Genetic Susceptibility ◽  
Ryanodine Receptor ◽  
Illicit Drugs ◽  
Positive Family History ◽  
Prescription Medication ◽  
Future Research ◽  
Wide Range ◽  
Recurrent Rhabdomyolysis ◽  
History Of ◽  
Medical Disciplines

: Variants in the ryanodine receptor-1 gene (RYR1) have been associated with a wide range of neuromuscular conditions, including various congenital myopathies and malignant hyperthermia (MH). More recently, a number of RYR1 variants, mostly MH-associated, have been demonstrated to contribute to rhabdomyolysis events not directly related to anesthesia in otherwise healthy individuals. This review focuses on RYR1-related rhabdomyolysis, in the context of several clinical presentations (i.e., exertional rhabdomyolysis, exertional heat illnesses and MH), and conditions involving a similar hypermetabolic state, in which RYR1 variants may be present (i.e., neuroleptic malignant syndrome and serotonin syndrome). The variety of triggers that can evoke rhabdomyolysis, on their own or in combination, as well as the number of potentially associated complications, illustrates that this is a condition relevant to several medical disciplines. External triggers include but are not limited to strenuous physical exercise, especially if unaccustomed or performed under challenging environmental conditions (e.g., high ambient temperature or humidity), alcohol/illicit drugs, prescription medication (in particular statins, other anti-lipid agents, antipsychotics and antidepressants) infection, or heat. Amongst all patients presenting with rhabdomyolysis, a genetic susceptibility is present in a proportion, with RYR1 being one of the most common genetic causes. Clinical clues for a genetic susceptibility include recurrent rhabdomyolysis, creatine kinase (CK) levels above 50 times the upper limit of normal, hyperCKemia lasting for 8 weeks or longer, drug/medication doses insufficient to explain the rhabdomyolysis event, and a positive family history. For the treatment or prevention of RYR1-related rhabdomyolysis, the RYR1 antagonist dantrolene can be administered, both in the acute phase, or prophylactically in patients with a history of muscle cramps and/or recurrent rhabdomyolysis events. Aside from dantrolene, several other drugs are being investigated for their potential therapeutic use in RYR1-related disorders. These findings offer further therapeutic perspectives for humans, suggesting an important area for future research.

Treatment of severe tricyclic antidepressant overdose with extracorporeal sorbent detoxification

2002 ◽  
Vol 9 (1) ◽  
pp. 31-41 ◽  
Author(s):  
Stephen R. Ash ◽  
Howard Levy ◽  
Mohammed Akmal ◽  
Rita A. Mankus ◽  
James M. Sutton ◽  
...  
Keyword(s):  
Tricyclic Antidepressant ◽  
Antidepressant Overdose ◽  
Tricyclic Antidepressant Overdose
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