Medical toxicology最新文献_第5页

Cathartics and laxatives. Do they still have a place in management of the poisoned patient? 泻药和泻药。他们在中毒病人的管理中还有一席之地吗？

Medical toxicology Pub Date : 1986-07-01 DOI: 10.1007/BF03259841

M Shannon, S S Fish, F H Lovejoy

引用次数: 0

Ocular toxicity from systemic drug therapy. An overview of clinically important adverse reactions. 全身药物治疗引起的眼毒性。临床重要不良反应概述。

Medical toxicology Pub Date : 1986-05-01 DOI: 10.1007/BF03259838

S I Davidson, I G Rennie

引用次数: 18

H2-receptor antagonists and gastric cancer. h2受体拮抗剂与胃癌。

Medical toxicology Pub Date : 1986-05-01 DOI: 10.1007/BF03259835

J Penston, K G Wormsley

引用次数: 8

Adverse reactions and interactions with H2-receptor antagonists. 不良反应和与h2受体拮抗剂的相互作用。

Medical toxicology Pub Date : 1986-05-01 DOI: 10.1007/BF03259837

J Penston, K G Wormsley

{"title":"Adverse reactions and interactions with H2-receptor antagonists.","authors":"J Penston, K G Wormsley","doi":"10.1007/BF03259837","DOIUrl":"10.1007/BF03259837","url":null,"abstract":"Histamine H2-receptor antagonists have been used in the treatment of gastrointestinal diseases for more than a decade and during this period have become one of the most commonly prescribed groups of drugs in the world. The deserved popularity of the H2-receptor antagonists reflects, in part, their therapeutic efficacy, which has revolutionised the treatment of peptic ulcer disease. An equally, or more, important reason for the widespread use of H2-receptor antagonists is their remarkably low toxicity. We have attempted, in this review, to present a detailed account of the minor and more serious adverse reactions, while emphasising the low incidence of the former and the rarity of the latter. The toxicology of the H2-receptor antagonists is discussed under two main headings: adverse effects; and drug interactions. The latter category is potentially the more significant, since the frequent use of therapy with multiple drugs may give rise to drug interactions, some of which are serious and may even be lethal. These drug interactions occur especially in the gastrointestinal tract, the liver and the kidneys. Thus, the absorption of other drugs may be altered because the H2-receptor antagonists inhibit gastric secretion--an effect illustrated by ketoconazole, the absorption of which is reduced when given in combination with cimetidine. Very important drug interactions are caused by inhibition of the hepatic microsomal enzyme cytochrome P450 by some of the H2-receptor antagonists. This effect appears to be related to the chemical structure of the individual H2-receptor antagonists and is not attributable to histamine H2-receptor blockade. For example, cimetidine is a powerful inhibitor of cytochrome P450, while the interaction of ranitidine with this system is weaker. Consequently, cimetidine reduces the metabolism of many drugs which are normally degraded by phase I reactions, leading to potentially toxic plasma concentrations of therapeutic agents such as some oral anticoagulants, beta-blockers, anticonvulsants, benzodiazepines and xanthines. Some of the H2-receptor antagonists are actively secreted by the renal tubules and may thus compete with other drugs for cationic tubular transport mechanisms, resulting in reduced urinary excretion and hence potentially toxic plasma concentrations. This type of drug interaction has been reported after administration of both cimetidine and ranitidine with procainamide or quinidine.(ABSTRACT TRUNCATED AT 400 WORDS)","PeriodicalId":77871,"journal":{"name":"Medical toxicology","volume":"1 3","pages":"192-216"},"PeriodicalIF":0.0,"publicationDate":"1986-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14015936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Theophylline poisoning. Pharmacological considerations and clinical management. 茶碱中毒。药理学考虑和临床管理。

Medical toxicology Pub Date : 1986-05-01 DOI: 10.1007/BF03259836

P Gaudreault, J Guay

{"title":"Theophylline poisoning. Pharmacological considerations and clinical management.","authors":"P Gaudreault, J Guay","doi":"10.1007/BF03259836","DOIUrl":"10.1007/BF03259836","url":null,"abstract":"The recent marketing of slow release preparations of theophylline and new indications for the use of the drug have resulted in a marked increase in the sale of theophylline products. This phenomenon combined with the drug's highly variable pharmacokinetics has led to an increase in the number of theophylline intoxications. The morbidity and mortality rates associated with theophylline intoxication are significant. Therefore it is essential that clinicians are aware of the pathophysiology, clinical presentation and treatment of this poisoning. Theophylline intoxication mainly affects the gastrointestinal, cardiovascular and central nervous systems. Signs and symptoms range from mild gastrointestinal upset to serious central nervous system manifestations such as seizures, a symptom often associated with a bad prognosis. Theophylline serum concentrations are very useful for making decisions regarding treatment. However, their interpretation should take into account several factors such as the age of the patient and the type of intoxication (acute versus chronic). Prevention of gastrointestinal absorption should be the principal objective of treatment of an oral theophylline poisoning. The repetitive administration of activated charcoal not only prevents theophylline absorption but also increases its rate of Once absorbed, external methods such as haemodialysis and haemoperfusion can significantly accelerate the elimination of the drug from the body. Finally, the rapid suppression of seizures and cardiac arrhythmias are essential to prevent severe neurological sequelae and death. Since theophylline intoxication can be potentially life-threatening, its administration should be monitored with regular measurements of the serum theophylline concentration, especially in the very young and the very old.","PeriodicalId":77871,"journal":{"name":"Medical toxicology","volume":"1 3","pages":"169-91"},"PeriodicalIF":0.0,"publicationDate":"1986-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14660781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Role of 2,3-dimercaptosuccinic acid in the treatment of heavy metal poisoning. 2,3-二巯基琥珀酸在重金属中毒治疗中的作用。

Medical toxicology Pub Date : 1986-05-01 DOI: 10.1007/BF03259834

J H Graziano

引用次数: 115

Clinical toxicology in the neonatal intensive care unit. 新生儿重症监护病房的临床毒理学。

Medical toxicology Pub Date : 1986-05-01 DOI: 10.1007/BF03259839

W Banner

{"title":"Clinical toxicology in the neonatal intensive care unit.","authors":"W Banner","doi":"10.1007/BF03259839","DOIUrl":"https://doi.org/10.1007/BF03259839","url":null,"abstract":"The role of the clinical toxicologist in the neonatal nursery may be an extremely important one in the evaluation of epidemic-like toxic reactions occurring from: (a) the inappropriate use of medications; (b) the accidental contamination of parenterals; and (c) the introduction of relatively new products into the nursery environment. The newborn with high respiratory demands, thin epidermis with a large surface area to body mass ratio, and nutritional support being derived completely from parenteral sources provides a great number of routes of entry for the introduction of toxins. In approaching these problems, the clinician needs a structured approach in considering the impact of the route of administration, the contents of the product and the ability of the newborn to eliminate the toxin in question. In addition, some knowledge of the specialised structures and diseases of the newborn is required to adequately analyse the impact of a potential toxin on newborn disease processes. What we normally consider as adverse drug reactions are extremely rare in the neonate. Hypersensitivity phenomenon and the classic non-dose-related side effects described in adults are rare occurrences. This makes it a challenge for the clinical toxicologist to analyse and attempt to identify a toxic substance in the nursery. Having identified a toxin in the newborn, treatment may be complicated by the inability to use many of the standard forms of therapy, e.g. activated charcoal, diuresis, and extracorporeal removal. The lack of practicality of these procedures increases the necessity for good supportive care. Exchange transfusion, rarely considered in older children and adults, may offer the only viable option for rapid removal of a drug.","PeriodicalId":77871,"journal":{"name":"Medical toxicology","volume":"1 3","pages":"225-35"},"PeriodicalIF":0.0,"publicationDate":"1986-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03259839","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14902897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Adverse reactions with angiotensin converting enzyme (ACE) inhibitors. 血管紧张素转换酶抑制剂的不良反应。

Medical toxicology Pub Date : 1986-03-01 DOI: 10.1007/BF03259832

R DiBianco

{"title":"Adverse reactions with angiotensin converting enzyme (ACE) inhibitors.","authors":"R DiBianco","doi":"10.1007/BF03259832","DOIUrl":"10.1007/BF03259832","url":null,"abstract":"Teprotide, a nonapeptide isolated from the venom of a Brazilian pit viper, Bothrops jararaca, was the first angiotensin converting enzyme (ACE) inhibitor to be discovered and tested. It was found to be an effective, non-toxic antihypertensive agent as well as an afterload-reducing agent for patients with congestive heart failure (CHF). The primary activity of teprotide resulted from blockade of the angiotensin I converting enzyme--the pivotal step in the renin-angiotensin-aldosterone system (RAAS), and consequent reductions in angiotensin II levels. There was limited clinical testing for teprotide because of: its scarcity; the need for parenteral administration; and the subsequent discovery and synthesis of captopril, the first orally active angiotensin converting enzyme inhibitor. Captopril is the prototype oral angiotensin converting enzyme inhibitor and has been extensively studied since the initiation of formal studies in 1976. Perhaps one of the most closely researched drugs in modern times, the experience with captopril now includes more than 12,000 patients studied in formalized trials and over 4,000,000 patients treated world-wide by physicians for hypertension and congestive heart failure. Enalapril (MK421) is the first of what appears to be a growing number of analogues which are structurally and pharmacodynamically different from captopril; yet, they possess the same capacity for inhibiting the activity of angiotensin converting enzyme. The side effect profile of enalapril (and presumably future) angiotensin converting enzyme inhibitors appears to be similar to captopril, though clearly more experience is needed with newer agents. The initial use of captopril was troubled by a relatively high incidence of side effects which will form the focus of this discussion. Partially the result of incomplete pharmacokinetic information, captopril was administered in early studies at dosages now recognised to be far in excess of those necessary for drug action. In addition, dosages were given without regard for deficiencies of renal function, now known to be the main excretory route of captopril. The population of those patients studied frequently had chronic, treatment-resistant hypertension, often associated with concomitant end-organ disease (especially renal disease); and many additional factors further complicating the clinical setting, e.g. a relatively high incidence of collagen vascular disease and immunosuppressive treatments.(ABSTRACT TRUNCATED AT 400 WORDS)","PeriodicalId":77871,"journal":{"name":"Medical toxicology","volume":"1 2","pages":"122-41"},"PeriodicalIF":0.0,"publicationDate":"1986-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14156806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gastric emptying. Risk versus benefit in the treatment of acute poisoning. 胃排空。急性中毒治疗的风险与收益。

Medical toxicology Pub Date : 1986-03-01 DOI: 10.1007/BF03259833

D H Wheeler-Usher, L A Wanke, M J Bayer

{"title":"Gastric emptying. Risk versus benefit in the treatment of acute poisoning.","authors":"D H Wheeler-Usher, L A Wanke, M J Bayer","doi":"10.1007/BF03259833","DOIUrl":"https://doi.org/10.1007/BF03259833","url":null,"abstract":"This review examines the various clinical options used to elicit gastric emptying, viz. drug-induced emesis, mechanical pharyngeal stimulation, gastric lavage, and catharsis. Apomorphine and syrup of ipecac are the 2 drugs most frequently used for induction of emesis. Both agents act centrally and, in addition, syrup of ipecac has a peripheral action. Toxins ingested or foods previously eaten may inhibit or enhance emetic action by interfering with mediating and conducting mechanisms. Studies indicate that both syrup of ipecac and apomorphine are similarly effective in inducing emesis; however, apomorphine has a shorter reaction time compared with syrup of ipecac. There are more risks involved with the use of apomorphine, since it causes central nervous system and respiratory depression. Syrup of ipecac has been shown to be relatively safe when used in its recommended dosage for emesis. However, several toxicities have been reported with the use of the fluid extract of ipecac. Emesis is contraindicated in patients who are obtunded or comatose, and in patients who have ingested stimulants, some hydrocarbons, or corrosives. Mechanical pharyngeal stimulation is a simple method of inducing emesis; however, it is often unsuccessful and rarely recovers a significant portion of the gastric contents. Gastric lavage is a procedure which has been relied upon for over a century. Its effectiveness is dependent on the nature, form, and dosage of the poison, latency between time of ingestion and lavage, and technique. In clinical experiments studying gastric lavage, it has been noted that the procedure is most beneficial 1 to 2 hours postingestion for the majority of poison ingestions. Lavage also provides an excellent route for activated charcoal and selected antidotes. Gastric lavage may pose several risks to the patient, including obstruction and contamination of the airways and oesophageal damage. Contraindications for gastric lavage are similar to those for emesis except that it may be safer to use in obtunded, comatose, or uncooperative patients. Cathartics used during initial poisoning therapy are usually the saline cathartics. They elicit an osmotic reaction in the small intestine which results in increased intraluminal fluid bulk, hyperperistalsis, and subsequent propulsion of contents. Cathartics have also been shown to stimulate the secretion of cholecystokinin, which is thought to have similar effects on the intestine. Cathartics have not been shown to significantly enhance drug elimination from the gastrointestinal tract.(ABSTRACT TRUNCATED AT 400 WORDS)","PeriodicalId":77871,"journal":{"name":"Medical toxicology","volume":"1 2","pages":"142-53"},"PeriodicalIF":0.0,"publicationDate":"1986-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03259833","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14902890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 18

Management of acute iron poisoning. 急性铁中毒的处理。

Medical toxicology Pub Date : 1986-03-01 DOI: 10.1007/BF03259830

A T Proudfoot, D Simpson, E H Dyson

{"title":"Management of acute iron poisoning.","authors":"A T Proudfoot, D Simpson, E H Dyson","doi":"10.1007/BF03259830","DOIUrl":"10.1007/BF03259830","url":null,"abstract":"Acute iron poisoning is most common in children below the age of 5 years. While there is no doubt that it may be fatal, recent surveys show that death occurs in only a very small percentage of cases and that iron salts are responsible for a small minority of fatalities due to overdosage with drugs. Similarly, the proportion of severe cases seems to have fallen over the last thirty years, possibly due to earlier and more aggressive treatment but more probably due to an increase in the number of minor exposures reported. Iron salts are directly toxic to the gastrointestinal tract causing vomiting, diarrhoea, abdominal pain and occasionally significant blood loss. They also cause metabolic acidosis by interfering with intermediary metabolism and producing shock and reduced tissue perfusion. The clinical course of acute iron poisoning is divided into 4 phases. Features of acute gastrointestinal irritation dominate the period up to 6 hours after ingestion and most patients do not develop other features or progress beyond this stage. Rarely, blood loss may be sufficient to cause hypotension. Severe poisoning is characterised by impairment of consciousness, convulsions and metabolic acidosis. The second phase, 6 to 12 hours after ingestion, is one of remission of features. Phase 3 comprises the period 12 to 48 hours from ingestion and is reached only by a small minority of patients. Recurrence or development of shock, and metabolic acidosis are usual and renal failure and features of extensive hepatocellular necrosis may develop. The last (fourth) phase, 2 to 6 weeks after ingestion, is only likely to develop in young children and is characterised by recurrence of vomiting due to gastric or duodenal stenosis caused by healing of iron-induced mucosal ulcers. Acute iron poisoning in humans has not been adequately studied and is unlikely to be so now because of the infrequent and sporadic occurrence of cases. The evidence for many conventional aspects of management is therefore unsatisfactory. Assessment of severity of poisoning is an essential prerequisite to optimum management but is difficult. The amount of elemental iron ingested is unacceptable since it is seldom known with accuracy and absorption is unpredictable because of vomiting and diarrhoea. The commonly encountered clinical features are also unreliable although it is generally accepted that coma, shock and metabolic acidosis indicate severe poisoning.(ABSTRACT TRUNCATED AT 400 WORDS)","PeriodicalId":77871,"journal":{"name":"Medical toxicology","volume":"1 2","pages":"83-100"},"PeriodicalIF":0.0,"publicationDate":"1986-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14902894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0