This document discusses drug overdoses, including definitions, common drugs involved, risk factors, evaluation and treatment. It notes that overdoses can be intentional or accidental and are a major cause of morbidity and mortality worldwide. The most common drugs involved in overdoses are opioid analgesics and benzodiazepines. Men ages 45-49 have the highest death rates. Evaluation involves assessing vital signs and mental status while treatment focuses on stabilization, supportive care, prevention of further exposure, and administration of antidotes if available.
This document provides information on managing poisoned patients. It discusses that all substances can be toxic in high enough doses. It outlines the goals of initial treatment which are to stabilize the patient and manage their airway, breathing, circulation and glucose levels (ABCDs). A full assessment includes obtaining the patient's history, performing a physical exam and conducting laboratory tests to identify the toxic substance and provide appropriate treatment.
This document provides information on managing poisoned patients. It discusses that all substances can be toxic in high enough doses. It outlines the goals of initial treatment which are to stabilize the patient and manage their airway, breathing, circulation and glucose levels (ABCDs). A full assessment includes obtaining the patient's history, performing a physical exam and conducting laboratory tests to identify the toxic substance and provide appropriate treatment.
A) Obtaining a thorough history from the patient, family members, or witnesses is essential to determine what toxin or drug was ingested, how much, and when. The physical examination focuses on vital signs, eyes, skin, nervous system, lungs and heart to identify symptoms that can indicate the toxin class. Recognizing a toxidrome pattern of signs and symptoms can help identify the possible toxin. Initial treatment priorities are stabilizing the airway, breathing, circulation and providing dextrose for altered mental status.
The document discusses drug overdose poisoning and provides information on:
1. Drug overdose occurs when drugs are consumed in excessive amounts, either intentionally or unintentionally, and injure the body.
2. Drug overdose is a leading cause of injury death, especially among those aged 25-64. Opioids and benzodiazepines are commonly involved in overdoses.
3. Risk factors for overdose include being male, white, and between ages 45-49. Children under 15 have the lowest overdose rates.
This document discusses the diagnosis and management of uncommon poisonings, including pesticides, herbicides, carbon monoxide, cyanide, and various toxins. It focuses on organophosphate and carbamate poisoning, providing details on the mechanisms of toxicity, clinical features including acute cholinergic syndrome, intermediate syndrome and delayed sequelae. Treatment involves resuscitation, anticholinergic agents like atropine, cholinesterase reactivators like pralidoxime, and other supportive therapies. Paraquat poisoning is also discussed, noting the progression to pulmonary fibrosis and respiratory failure as the main cause of death.
The document discusses the evaluation and management of acute poisoning. It defines key terms like poisons, toxins, and toxidromes. It then outlines the steps of evaluation including history, examination, investigations, and management. The assessment and therapy should proceed in parallel and follow advanced cardiac life support principles of evaluating airway, breathing, circulation, and drugs. Signs and symptoms are categorized by system. Guidelines are provided for patient admission to intensive care.
Chap 1 General principles involved in the management of poisoningChanukya Vanam . Dr
1. General principles involved in the management of poisoning
2. Antidotes and the clinical applications.
3. Supportive care in clinical Toxicology.
4. Gut Decontamination.
5. Elimination Enhancement.
6. Toxicokinetics.
Approach to drug poisoning in adults by Dr Alaa Elmassryalaa massry
This document provides information on drug overdoses and poisonings. It begins with an introduction by Dr. Alaa Eldeen Elmassry. It then poses questions about the epidemiology, toxidrome patterns, therapy, and specific poisonings clinicians may face. The rest of the document addresses these questions and topics, covering areas like cyanide poisoning treatment, opiate overdose signs, toxic ingestion differentials, effects of overdose vs. therapeutic doses, gastric decontamination, paracetamol overdose facts, poisoning statistics, toxic syndromes, vital signs and examinations in poisonings, and diagnostic tests.
This document provides information on managing poisoned patients. It discusses that all substances can be toxic in high enough doses. It outlines the goals of initial treatment which are to stabilize the patient and manage their airway, breathing, circulation and glucose levels (ABCDs). A full assessment includes obtaining the patient's history, performing a physical exam and conducting laboratory tests to identify the toxic substance and provide appropriate treatment.
This document provides information on managing poisoned patients. It discusses that all substances can be toxic in high enough doses. It outlines the goals of initial treatment which are to stabilize the patient and manage their airway, breathing, circulation and glucose levels (ABCDs). A full assessment includes obtaining the patient's history, performing a physical exam and conducting laboratory tests to identify the toxic substance and provide appropriate treatment.
A) Obtaining a thorough history from the patient, family members, or witnesses is essential to determine what toxin or drug was ingested, how much, and when. The physical examination focuses on vital signs, eyes, skin, nervous system, lungs and heart to identify symptoms that can indicate the toxin class. Recognizing a toxidrome pattern of signs and symptoms can help identify the possible toxin. Initial treatment priorities are stabilizing the airway, breathing, circulation and providing dextrose for altered mental status.
The document discusses drug overdose poisoning and provides information on:
1. Drug overdose occurs when drugs are consumed in excessive amounts, either intentionally or unintentionally, and injure the body.
2. Drug overdose is a leading cause of injury death, especially among those aged 25-64. Opioids and benzodiazepines are commonly involved in overdoses.
3. Risk factors for overdose include being male, white, and between ages 45-49. Children under 15 have the lowest overdose rates.
This document discusses the diagnosis and management of uncommon poisonings, including pesticides, herbicides, carbon monoxide, cyanide, and various toxins. It focuses on organophosphate and carbamate poisoning, providing details on the mechanisms of toxicity, clinical features including acute cholinergic syndrome, intermediate syndrome and delayed sequelae. Treatment involves resuscitation, anticholinergic agents like atropine, cholinesterase reactivators like pralidoxime, and other supportive therapies. Paraquat poisoning is also discussed, noting the progression to pulmonary fibrosis and respiratory failure as the main cause of death.
The document discusses the evaluation and management of acute poisoning. It defines key terms like poisons, toxins, and toxidromes. It then outlines the steps of evaluation including history, examination, investigations, and management. The assessment and therapy should proceed in parallel and follow advanced cardiac life support principles of evaluating airway, breathing, circulation, and drugs. Signs and symptoms are categorized by system. Guidelines are provided for patient admission to intensive care.
Chap 1 General principles involved in the management of poisoningChanukya Vanam . Dr
1. General principles involved in the management of poisoning
2. Antidotes and the clinical applications.
3. Supportive care in clinical Toxicology.
4. Gut Decontamination.
5. Elimination Enhancement.
6. Toxicokinetics.
Approach to drug poisoning in adults by Dr Alaa Elmassryalaa massry
This document provides information on drug overdoses and poisonings. It begins with an introduction by Dr. Alaa Eldeen Elmassry. It then poses questions about the epidemiology, toxidrome patterns, therapy, and specific poisonings clinicians may face. The rest of the document addresses these questions and topics, covering areas like cyanide poisoning treatment, opiate overdose signs, toxic ingestion differentials, effects of overdose vs. therapeutic doses, gastric decontamination, paracetamol overdose facts, poisoning statistics, toxic syndromes, vital signs and examinations in poisonings, and diagnostic tests.
Si el envenenamiento es reconocido de forma temprana y reciben una atención medica adecuada, el pronostico es favorable.
La exposición a toxinas puede ocurrir por accidente (es decir, incidentes o interacciones medicamentosas) o intencionalmente (es decir, el abuso de sustancias o ingestas intencionales).
El envenenamiento depende de numerosos factores, como el tipo de sustancia, la dosis, el tiempo de exposición a la presentación a un centro de atención a la salud y el estado de salud preexistente del paciente.
This document discusses clinical toxicology. Some key points:
- Clinical toxicology is the study of toxic or adverse effects of drugs and chemicals in the body. Clinical toxicologists identify, diagnose, and treat conditions resulting from exposure to harmful agents.
- Several factors influence the toxic effect of a substance, including dose, route of exposure, and duration of exposure.
- Initial evaluation of a patient with a suspected toxic exposure focuses on airway, breathing, circulation, and mental status. Vital signs and developing toxic syndromes provide clues to identify toxic agents. Serial monitoring of vital signs is important to assess treatment effectiveness.
The document discusses toxicology and poison control. It provides information on common toxic exposures including drugs, chemicals, plants and animals. Poison control centers provide treatment advice and education on poisonings. They are responsible for toxicology consultation, data collection, education and research. Early identification of poisoning is important for successful management. The majority of poisonings occur in the home and involve young children.
- The document provides an overview of how to approach and manage a poisoned patient. It discusses toxicology, common reasons for overdoses, assessing risk, supportive care including monitoring and investigations, gastrointestinal decontamination, enhanced elimination, antidotes, potential complications, and disposition.
- Key aspects of the approach and management include the RRISDEAD method of resuscitation, risk assessment, supportive care, investigations, decontamination, enhanced elimination, antidotes, and disposition. Supportive care involves airway, breathing, circulation support as well as monitoring, fluid management, and treating secondary issues like seizures.
- Specific toxic syndromes discussed include anticholinergic syndrome, serotonin syndrome, and
This document discusses poisoning and its management. It begins by defining what a poison is and the different types of poisoning, including deliberate, accidental, environmental, and industrial exposures. It then describes common symptoms of poisoning and considerations for managing poisoned patients, including resuscitation, toxicological diagnosis, and therapeutic interventions like decontamination and antidotes. The diagnostic process involves obtaining a thorough history, conducting a physical exam looking for clues, and ordering targeted toxicology investigations to determine the poison involved and properly manage the patient.
In this presentation Pharmacology III Unit V covered
Following points are included;
Various Definitions:
Acute toxicity
Subacute toxicity
Chronic toxicity
Genotoxicity,
Carcinogenicity,
Teratogenicity
Mutagenicity
General principles of treatment of poisoning
Clinical symptoms and management of various poisoning conditions.
like Barbiturate poisoning, Morphinpoisoning, Organophosphoruspoisoning, Lead poisoning, mercury poisoning, Arsenin poisoning, And its specific antidote
Substances use and addictive disorders overview GaylordInena
This document provides an overview of substance use and addictive disorders. It discusses terminology related to substance use, including abuse, misuse, addiction, dependence, withdrawal, and tolerance. It then covers the epidemiology of substance use globally and in specific countries like Uganda, DRC, and Rwanda. The etiology of substance use disorders is complex and involves multiple interacting factors, including psychodynamic, genetic, and neurochemical factors. Learning and conditioning theories also play a role in dependence and relapse.
The document discusses drug induced diseases (DIDs), which are unintended harmful effects caused by medications. DIDs can affect many organ systems and cause conditions like skin disorders, lung disease, gastrointestinal issues, and neurological or kidney problems. Common causes of DIDs include nonsteroidal anti-inflammatory drugs, antibiotics, anticancer drugs, and anticonvulsants. DIDs are diagnosed based on symptoms occurring after drug intake. Treatment involves stopping the causative medication and managing symptoms. Preventing DIDs requires informing doctors of medical histories and only taking drugs as prescribed. DIDs remain an important health issue requiring more comprehensive research.
ADRs
Classifications of ADRs
Thompson and DoTS system classification
Factors: age, gender, Co-morbidities, ethnicity, Pharmacogenetics,G6PD deficiency, porphyrias
Immunological reactions
Classifications
Epidemiology and pharmacovigilance of ADRs
Yellow card scheme,
Thalidomide tragedy
Factors that may raise or suppress suspicion of a drug
The document discusses the evaluation and management of pediatric toxic exposures and ingestions, including general principles, potentially toxic ingestions of 1-3 tablets, emergency management of airway, breathing, circulation and other systems, decontamination methods, specific toxic syndromes and antidotes, and case examples of ethanol and iron ingestions. Management involves stabilization, decontamination if indicated, treatment of specific toxic effects, and consideration of toxicology studies and antidotes based on the exposure.
This document discusses clinical toxicology and the management of poisoned patients. It begins by explaining factors that contribute to the action of poisons, such as dose, form, route of administration, and individual physiology. It then outlines the six key steps in managing a poisoned patient: 1) stabilization, 2) diagnosis, 3) preventing further absorption, 4) enhancing elimination, 5) administering antidotes, and 6) providing supportive care. Specific techniques to prevent further absorption discussed include decontamination, induced vomiting, gastric lavage, and use of activated charcoal or laxatives. The goal of management is to stabilize the patient and keep toxin levels low through prevention of absorption and increased elimination.
This document summarizes organophosphorus insecticides and nerve gas agents poisoning. It discusses the mechanisms, clinical manifestations and management of organophosphorus poisoning, which can cause acute cholinergic crisis, intermediate syndrome and organophosphate-induced delayed polyneuropathy. Treatment involves decontamination, atropine to block muscarinic effects, oximes like pralidoxime to reactivate acetylcholinesterase, and ventilatory support for respiratory failure and intermediate syndrome. Prognosis depends on dose, toxicity of agent and timeliness of treatment.
This document discusses toxicology and toxidromes. It defines toxicology as the study of poisons and their effects. It describes different areas of toxicology like forensic, environmental and occupational toxicology. It also discusses factors that affect toxic responses and the medicolegal aspects of poisoning cases. Finally, it defines toxidromes as syndromes caused by specific poisons and names some common toxidromes like anticholinergic, sympathormimetic, cholinergic, opioid and benzodiazepine toxidromes, describing the symptoms and causes of each.
The document discusses various psychotropic medications used in psychiatry including:
1. Antipsychotics such as first-generation antipsychotics which are dopamine receptor antagonists and second-generation antipsychotics which are serotonin-dopamine antagonists or partial dopamine agonists.
2. Antidepressants which include MAOIs, TCAs, SSRIs, SNRIs, and others.
3. Mood stabilizers indicated for bipolar disorder.
4. Benzodiazepines which are commonly used as anxiolytics.
5. Anticholinergic drugs which are primarily used to treat medication-induced movement disorders.
Organophosphorus compounds are widely used as pesticides and chemical weapons. They work by inhibiting acetylcholinesterase, leading to accumulation of acetylcholine and overstimulation of nicotinic and muscarinic receptors. Clinical features include excessive secretions, nausea, vomiting, diarrhea, weakness and respiratory failure. Treatment involves decontamination, atropine to block muscarinic effects, pralidoxime to reactivate acetylcholinesterase, and supportive care. Prognosis depends on prompt diagnosis and treatment, with mortality risks highest within 24 hours from respiratory or cardiac failure.
Metoprolol is a beta-blocker used to treat hypertension, angina, and myocardial infarction. It works by blocking beta-1 receptors in the heart, lowering heart rate and blood pressure. Common side effects include dizziness, fatigue, shortness of breath, and diarrhea. It interacts with many other drugs and its effects are influenced by CYP2D6 metabolism and genetic polymorphisms. To improve safety, medication reconciliation should be done within 20 minutes of admission and the profile updated regularly while educating the patient.
This document provides information on poisoning epidemiology and management. It notes that over 90% of toxic exposures occur in the home and most involve a single substance, with ingestion being the most common route. It describes the initial evaluation and treatment of patients, including decontamination procedures, supportive care, and administration of antidotes. Specific signs and symptoms of various types of poisonings and poison syndromes are also outlined. The document emphasizes the importance of supportive care, prevention of further poison absorption, and enhancement of poison elimination in management.
This presentation was done on the 'First Qilu Doctoral Forum on Health Economy and Policy' Conference on 15th May 2019 at Shandong University, Jinan, China
This document discusses adverse drug reactions (ADRs), including definitions from WHO and FDA, classification of ADRs as Type A or B reactions, factors affecting ADR incidence and severity, and methods for detecting and monitoring ADRs. It provides details on the national pharmacovigilance program in Nepal and the role pharmacists play in ADR monitoring and pharmacovigilance.
This document defines and describes various types of adverse drug reactions and events. It discusses pharmacovigilance, which is the science related to detecting, assessing, understanding, and preventing adverse drug effects. The document categorizes adverse drug effects into side effects, allergy reactions, toxicity, intolerance, idiosyncrasy, photosensitivity, dependence, withdrawal reactions, teratogenicity, mutagenicity, carcinogenicity, and drug-induced diseases. It provides examples and treatments for different types of reactions. Pharmacovigilance helps educate doctors about adverse drug reactions and regulates safe drug use.
This document discusses a case of multiple endocrine neoplasia type 1 (MEN1) in a 46-year-old female patient and her brother. The patient presented with symptoms of hypoglycemia and was found to have hyperparathyroidism, a pituitary adenoma, and insulinomas. Genetic testing confirmed a MEN1 gene mutation. Her brother also had features of MEN1 including acromegaly, hyperparathyroidism, and insulinomas. MEN1 is a rare genetic disorder characterized by tumors of the parathyroid glands, anterior pituitary, and pancreatic islet cells. Early detection of MEN1-associated tumors through genetic screening and biochemical monitoring of at-risk family members
Si el envenenamiento es reconocido de forma temprana y reciben una atención medica adecuada, el pronostico es favorable.
La exposición a toxinas puede ocurrir por accidente (es decir, incidentes o interacciones medicamentosas) o intencionalmente (es decir, el abuso de sustancias o ingestas intencionales).
El envenenamiento depende de numerosos factores, como el tipo de sustancia, la dosis, el tiempo de exposición a la presentación a un centro de atención a la salud y el estado de salud preexistente del paciente.
This document discusses clinical toxicology. Some key points:
- Clinical toxicology is the study of toxic or adverse effects of drugs and chemicals in the body. Clinical toxicologists identify, diagnose, and treat conditions resulting from exposure to harmful agents.
- Several factors influence the toxic effect of a substance, including dose, route of exposure, and duration of exposure.
- Initial evaluation of a patient with a suspected toxic exposure focuses on airway, breathing, circulation, and mental status. Vital signs and developing toxic syndromes provide clues to identify toxic agents. Serial monitoring of vital signs is important to assess treatment effectiveness.
The document discusses toxicology and poison control. It provides information on common toxic exposures including drugs, chemicals, plants and animals. Poison control centers provide treatment advice and education on poisonings. They are responsible for toxicology consultation, data collection, education and research. Early identification of poisoning is important for successful management. The majority of poisonings occur in the home and involve young children.
- The document provides an overview of how to approach and manage a poisoned patient. It discusses toxicology, common reasons for overdoses, assessing risk, supportive care including monitoring and investigations, gastrointestinal decontamination, enhanced elimination, antidotes, potential complications, and disposition.
- Key aspects of the approach and management include the RRISDEAD method of resuscitation, risk assessment, supportive care, investigations, decontamination, enhanced elimination, antidotes, and disposition. Supportive care involves airway, breathing, circulation support as well as monitoring, fluid management, and treating secondary issues like seizures.
- Specific toxic syndromes discussed include anticholinergic syndrome, serotonin syndrome, and
This document discusses poisoning and its management. It begins by defining what a poison is and the different types of poisoning, including deliberate, accidental, environmental, and industrial exposures. It then describes common symptoms of poisoning and considerations for managing poisoned patients, including resuscitation, toxicological diagnosis, and therapeutic interventions like decontamination and antidotes. The diagnostic process involves obtaining a thorough history, conducting a physical exam looking for clues, and ordering targeted toxicology investigations to determine the poison involved and properly manage the patient.
In this presentation Pharmacology III Unit V covered
Following points are included;
Various Definitions:
Acute toxicity
Subacute toxicity
Chronic toxicity
Genotoxicity,
Carcinogenicity,
Teratogenicity
Mutagenicity
General principles of treatment of poisoning
Clinical symptoms and management of various poisoning conditions.
like Barbiturate poisoning, Morphinpoisoning, Organophosphoruspoisoning, Lead poisoning, mercury poisoning, Arsenin poisoning, And its specific antidote
Substances use and addictive disorders overview GaylordInena
This document provides an overview of substance use and addictive disorders. It discusses terminology related to substance use, including abuse, misuse, addiction, dependence, withdrawal, and tolerance. It then covers the epidemiology of substance use globally and in specific countries like Uganda, DRC, and Rwanda. The etiology of substance use disorders is complex and involves multiple interacting factors, including psychodynamic, genetic, and neurochemical factors. Learning and conditioning theories also play a role in dependence and relapse.
The document discusses drug induced diseases (DIDs), which are unintended harmful effects caused by medications. DIDs can affect many organ systems and cause conditions like skin disorders, lung disease, gastrointestinal issues, and neurological or kidney problems. Common causes of DIDs include nonsteroidal anti-inflammatory drugs, antibiotics, anticancer drugs, and anticonvulsants. DIDs are diagnosed based on symptoms occurring after drug intake. Treatment involves stopping the causative medication and managing symptoms. Preventing DIDs requires informing doctors of medical histories and only taking drugs as prescribed. DIDs remain an important health issue requiring more comprehensive research.
ADRs
Classifications of ADRs
Thompson and DoTS system classification
Factors: age, gender, Co-morbidities, ethnicity, Pharmacogenetics,G6PD deficiency, porphyrias
Immunological reactions
Classifications
Epidemiology and pharmacovigilance of ADRs
Yellow card scheme,
Thalidomide tragedy
Factors that may raise or suppress suspicion of a drug
The document discusses the evaluation and management of pediatric toxic exposures and ingestions, including general principles, potentially toxic ingestions of 1-3 tablets, emergency management of airway, breathing, circulation and other systems, decontamination methods, specific toxic syndromes and antidotes, and case examples of ethanol and iron ingestions. Management involves stabilization, decontamination if indicated, treatment of specific toxic effects, and consideration of toxicology studies and antidotes based on the exposure.
This document discusses clinical toxicology and the management of poisoned patients. It begins by explaining factors that contribute to the action of poisons, such as dose, form, route of administration, and individual physiology. It then outlines the six key steps in managing a poisoned patient: 1) stabilization, 2) diagnosis, 3) preventing further absorption, 4) enhancing elimination, 5) administering antidotes, and 6) providing supportive care. Specific techniques to prevent further absorption discussed include decontamination, induced vomiting, gastric lavage, and use of activated charcoal or laxatives. The goal of management is to stabilize the patient and keep toxin levels low through prevention of absorption and increased elimination.
This document summarizes organophosphorus insecticides and nerve gas agents poisoning. It discusses the mechanisms, clinical manifestations and management of organophosphorus poisoning, which can cause acute cholinergic crisis, intermediate syndrome and organophosphate-induced delayed polyneuropathy. Treatment involves decontamination, atropine to block muscarinic effects, oximes like pralidoxime to reactivate acetylcholinesterase, and ventilatory support for respiratory failure and intermediate syndrome. Prognosis depends on dose, toxicity of agent and timeliness of treatment.
This document discusses toxicology and toxidromes. It defines toxicology as the study of poisons and their effects. It describes different areas of toxicology like forensic, environmental and occupational toxicology. It also discusses factors that affect toxic responses and the medicolegal aspects of poisoning cases. Finally, it defines toxidromes as syndromes caused by specific poisons and names some common toxidromes like anticholinergic, sympathormimetic, cholinergic, opioid and benzodiazepine toxidromes, describing the symptoms and causes of each.
The document discusses various psychotropic medications used in psychiatry including:
1. Antipsychotics such as first-generation antipsychotics which are dopamine receptor antagonists and second-generation antipsychotics which are serotonin-dopamine antagonists or partial dopamine agonists.
2. Antidepressants which include MAOIs, TCAs, SSRIs, SNRIs, and others.
3. Mood stabilizers indicated for bipolar disorder.
4. Benzodiazepines which are commonly used as anxiolytics.
5. Anticholinergic drugs which are primarily used to treat medication-induced movement disorders.
Organophosphorus compounds are widely used as pesticides and chemical weapons. They work by inhibiting acetylcholinesterase, leading to accumulation of acetylcholine and overstimulation of nicotinic and muscarinic receptors. Clinical features include excessive secretions, nausea, vomiting, diarrhea, weakness and respiratory failure. Treatment involves decontamination, atropine to block muscarinic effects, pralidoxime to reactivate acetylcholinesterase, and supportive care. Prognosis depends on prompt diagnosis and treatment, with mortality risks highest within 24 hours from respiratory or cardiac failure.
Metoprolol is a beta-blocker used to treat hypertension, angina, and myocardial infarction. It works by blocking beta-1 receptors in the heart, lowering heart rate and blood pressure. Common side effects include dizziness, fatigue, shortness of breath, and diarrhea. It interacts with many other drugs and its effects are influenced by CYP2D6 metabolism and genetic polymorphisms. To improve safety, medication reconciliation should be done within 20 minutes of admission and the profile updated regularly while educating the patient.
This document provides information on poisoning epidemiology and management. It notes that over 90% of toxic exposures occur in the home and most involve a single substance, with ingestion being the most common route. It describes the initial evaluation and treatment of patients, including decontamination procedures, supportive care, and administration of antidotes. Specific signs and symptoms of various types of poisonings and poison syndromes are also outlined. The document emphasizes the importance of supportive care, prevention of further poison absorption, and enhancement of poison elimination in management.
This presentation was done on the 'First Qilu Doctoral Forum on Health Economy and Policy' Conference on 15th May 2019 at Shandong University, Jinan, China
This document discusses adverse drug reactions (ADRs), including definitions from WHO and FDA, classification of ADRs as Type A or B reactions, factors affecting ADR incidence and severity, and methods for detecting and monitoring ADRs. It provides details on the national pharmacovigilance program in Nepal and the role pharmacists play in ADR monitoring and pharmacovigilance.
This document defines and describes various types of adverse drug reactions and events. It discusses pharmacovigilance, which is the science related to detecting, assessing, understanding, and preventing adverse drug effects. The document categorizes adverse drug effects into side effects, allergy reactions, toxicity, intolerance, idiosyncrasy, photosensitivity, dependence, withdrawal reactions, teratogenicity, mutagenicity, carcinogenicity, and drug-induced diseases. It provides examples and treatments for different types of reactions. Pharmacovigilance helps educate doctors about adverse drug reactions and regulates safe drug use.
This document discusses a case of multiple endocrine neoplasia type 1 (MEN1) in a 46-year-old female patient and her brother. The patient presented with symptoms of hypoglycemia and was found to have hyperparathyroidism, a pituitary adenoma, and insulinomas. Genetic testing confirmed a MEN1 gene mutation. Her brother also had features of MEN1 including acromegaly, hyperparathyroidism, and insulinomas. MEN1 is a rare genetic disorder characterized by tumors of the parathyroid glands, anterior pituitary, and pancreatic islet cells. Early detection of MEN1-associated tumors through genetic screening and biochemical monitoring of at-risk family members
This document provides guidelines for the treatment of dyslipidemia to reduce cardiovascular risk. It defines dyslipidemia as abnormal lipid levels measured in a blood sample. The guidelines classify risk based on LDL cholesterol, total cholesterol, and HDL cholesterol levels. They recommend screening adults over certain ages for lipid levels and cardiovascular risk. Risk is assessed using tools like the Framingham Risk Score. Treatment involves starting statin therapy, with the intensity based on a patient's risk category. Lifestyle changes and other medications may also be used. The guidelines aim to identify those who will benefit most from treatment to lower lipid levels and cardiovascular risk.
This document discusses drug-induced liver injury (DILI). It begins by stating that multiple drugs can cause hepatotoxicity through various mechanisms. It then discusses the epidemiology of DILI, noting that its worldwide annual incidence is estimated between 1.3 to 19.1 per 100,000 exposed individuals. The document outlines the pathogenesis, clinical presentation, diagnosis, classification, histology, and management of DILI. Regarding histology, it describes various patterns of injury that can be seen such as hepatocellular necrosis, cholestasis, steatosis, and sinusoidal obstruction syndrome. The primary treatment for DILI is withdrawal of the causative drug, with specific therapies for certain cases like
1) Aortic stenosis is a narrowing of the aortic valve that obstructs blood flow from the left ventricle to the aorta.
2) The most common presenting symptoms are dyspnea on exertion, exertional dizziness, and exertional angina, reflecting the stiff left ventricle's inability to increase cardiac output during exercise.
3) On examination, the carotid pulse is weak and slow rising, and a crescendo-decrescendo murmur is best heard at the right upper sternal border when leaning forward.
Scorpion stings, especially from the Indian red scorpion, are a major public health problem in tropical countries. The venom causes an autonomic storm that can lead to hypertension, pulmonary edema, hypotension and shock. Early symptoms include local pain, vomiting, sweating and priapism. Delayed treatment can result in high morbidity and mortality. Management involves fluid resuscitation, prazosin to block alpha receptors, vasodilators, antivenom and intensive care as needed for pulmonary edema or hypotension. Prevention focuses on reducing places scorpions may hide and using pesticides in endemic areas.
This document discusses acute HIV infection and CDC criteria for diagnosis. It defines acute HIV infection as occurring within approximately six months of infection. Symptoms may include fever, lymphadenopathy, sore throat, rash, and others nonspecific symptoms. Diagnosis is made by detecting HIV RNA during the window period before antibodies develop or with a positive combination antigen/antibody test and negative antibody-only test. Early diagnosis is important for individual treatment and reducing transmission.
head ache dizziness and sphincter disturbance s.pptxSruthi Meenaxshi
This document discusses several topics related to sensory disturbances:
1) It describes the anatomy of the sensory system and how sensations are transmitted from receptors to the central nervous system.
2) It defines different types of sensory loss or disturbances like hypoesthesia, anesthesia, hypalgesia, and hyperpathia.
3) It outlines how to perform a sensory examination to localize lesions, including testing touch, proprioception, vibration, temperature, and pain. Higher cortical sensations can also be examined.
Inflammatory Bowel Disease (IBD) represents a spectrum of chronic inflammatory conditions of the digestive tract including Ulcerative Colitis and Crohn's Disease. IBD is caused by an inappropriate immune response to intestinal bacteria in genetically predisposed individuals. Symptoms include diarrhea, abdominal pain, and weight loss. Treatment involves medications to reduce inflammation like aminosalicylates, corticosteroids, immunosuppressants, and biologics that target tumor necrosis factor-alpha. The goals of treatment are to induce and maintain remission of symptoms and prevent disease complications.
1. Premature ventricular contractions are early occurring, widened QRS complexes originating from the left or right ventricle that have a distinct morphology different from the normal sinus rhythm.
2. Ventricular tachycardia is defined as three or more successive ventricular complexes at a rate greater than 100 beats per minute and shows atrioventricular dissociation.
3. Ventricular fibrillation is identified by the complete absence of properly formed QRS complexes and P waves, with irregular ventricular activation above 300 beats per minute leading to cardiac arrest.
Digoxin toxicity can cause various arrhythmias due to its effects on intracellular calcium levels and vagal tone. Life-threatening arrhythmias may occur at plasma digoxin levels above 2.0 ng/mL. Hypokalemia and age over 65 increase toxicity risk. Symptoms include ectopic atrial tachycardia with block, various forms of AV block, and junctional rhythms. Distinguishing features between arrhythmias is important for appropriate treatment.
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/ARVC) is a genetic heart condition characterized by structural abnormalities and fatty infiltration of the right ventricle, leading to ventricular arrhythmias and sudden cardiac death. It is a common cause of sudden cardiac death in young athletes. Clinical features include palpitations, syncope, chest pain, and dyspnea. Diagnosis relies on a combination of ECG findings, echocardiogram abnormalities of the right ventricle, and genetic testing.
Left ventricular noncompaction (LVNC) is a heart muscle disorder characterized by excessive trabeculations and deep recesses in the left ventricle. It is diagnosed using echocardiography or cardiac MRI based on specific criteria. Symptoms vary and include heart failure, arrhythmias, and thromboembolic events like stroke. The cause involves abnormal heart muscle development during fetal life. Genetic factors are involved in some cases. Treatment focuses on managing symptoms and complications. Prognosis depends on the severity of symptoms and complications.
Vector borne diseases recent concepts in management and elimination targets...Sruthi Meenaxshi
This document discusses vector-borne diseases and strategies for their management and elimination. It begins by stating that vector-borne diseases account for 17% of infectious diseases globally, with malaria being the main contributor. Vectors transmit diseases between humans or animals. Vector management aims to optimize control and reduce incidence. Mosquitoes transmit diseases like malaria, dengue, chikungunya, Japanese encephalitis, and lymphatic filariasis. The National Vector Borne Disease Control Program integrates control of these diseases. Malaria elimination targets aim for transmission interruption in certain states by 2020 and nationwide by 2030. Integrated vector control includes insecticide spraying, bed nets, and source reduction.
This document discusses atrial septal defect (ASD) closure procedures. It describes that ASDs are often asymptomatic until adulthood but can lead to complications if left untreated. Preprocedural assessment includes echocardiography and additional imaging if needed. Surgical closure is preferred for primum, sinus venosus, and coronary sinus defects. Percutaneous closure is an alternative to surgery for secundum ASDs of appropriate size and anatomy. Percutaneous closure has comparable efficacy to surgery but shorter hospital stays and fewer complications. Complications of percutaneous closure include device embolization, arrhythmias, and erosion.
Echocardiography is the main tool for evaluating prosthetic heart valves. Transthoracic echocardiography (TTE) is generally used to assess normal valve function and identify dysfunction like stenosis or regurgitation. Transesophageal echocardiography (TEE) provides better imaging of valve structure and is helpful for evaluating regurgitation and complications like endocarditis. Echocardiograms establish a baseline after valve implantation and monitor for issues like pannus, thrombus, infection or degeneration over time. TTE and TEE are complementary, with TEE used when TTE is inadequate or clinical suspicion remains after a TTE.
Ventricular septal defects (VSDs) are openings in the wall separating the ventricles of the heart. There are four main types classified by location: membranous, muscular, supracristal, and inlet VSDs. Echocardiography is useful for diagnosing VSDs and assessing their characteristics like location, size, and impact on cardiac function. VSDs range from small and asymptomatic to large defects causing heart failure or pulmonary hypertension. Surgical or catheter-based closure may be required for large VSDs.
A 45 year old woman presented with shortness of breath on exertion. Echocardiography showed an atrial septal defect (ASD). ASDs are congenital heart defects where the wall separating the left and right atria is incomplete. The most common type is secundum ASD, which accounts for 70-75% of cases. ASDs allow blood to shunt from the left to the right atrium, overloading the right heart and lungs over time if not repaired. Echocardiography is the primary test to diagnose ASDs.
Echocardiography plays a key role in the diagnosis and management of infective endocarditis. It can identify valvular vegetations, abscesses, fistulas and other complications. The presence of an oscillating intracardiac mass or abscess on valves or endocardial surfaces are major echocardiographic criteria for the diagnosis. Transesophageal echocardiography is recommended if transthoracic is nondiagnostic or for complications. Follow up echos are important to monitor vegetation size with treatment and check for complications. Differentiating infective vegetations from other intracardiac masses or artifacts is important.
This document discusses different types of atrioventricular (AV) block and their classification. It describes:
- First, second, and third degree AV blocks, as well as high-grade block. Second degree block is further divided into Mobitz type I (Wenckebach) and type II.
- Etiologies of AV block.
- Class I indications for pacemaker placement, which include complete AV block and various types of symptomatic second degree block.
- Examples of ECGs demonstrating Wenckebach phenomenon, Mobitz type II block, complete heart block with and without myocardial infarction. Causes like muscular dystrophy are also discussed.
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Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
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Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
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3. DRUG OVERDOSE
Consumption of a therapeutic agent, drug, or narcotic, in excess of that required to produce the
desired effects.
When a drug is eaten, inhaled ,injected or absorbed through the skin in excessive amounts and injures
the body
Overdoses are either intentional or unintentional
Accidental and intentional poisonings or drug overdoses constitute a significant source of aggregate
morbidity, mortality, and health care expenditure worldwide.
4.
5. In 2018, over two million calls were made to United States poison control centers regarding known
or suspected human toxicities
The exact incidence of this problem in our country remains uncertain but it is estimated that about
10-15 million cases of drug overdose poisoning are reported every year ,of which ,more than
50,000 die
6.
7.
8. Most common drugs involved in overdoses
Of the 22,767 deaths relating to pharmaceutical overdose ,16,235 (71.3%) involved opioid
analgesics (Prescription painkillers) an 6973 (30.6%) involved benzodiazepines
Benzodiazepines are frequently found among people treated in ED s for misusing or abusing
drugs
People who died of drug overdoses often had a combination of benzodiazepines and opioid
analgesics in their bodies
9. Risk Factors for drug overdose
Men were 59 % more likely than women to die
High death rates among people 45-49 years of age
Lowest death rates were among children less than 15 years old
10. INITIAL EVALUATION AND TREATMENT
A brief initial screening examination should be performed on all patients to identify immediate
measures required to stabilize and prevent deterioration of the patient.
Assess the airway, vital signs, mental status, pupil size, and skin temperature and moisture.
Immediate diagnostic studies to be performed include pulse oximetry, continuous cardiac
monitoring, an electrocardiogram (ECG), and a capillary glucose measurement (in altered
patients).
Intravenous (IV) access should be obtained in all cases of serious ingestion.
11. In patients with suspected occult trauma, maintain in-line cervical immobilization.
In cases of suspected opioid toxicity, a brief trial of naloxone may be performed prior to
performing tracheal intubation, provided ventilation can be assisted using noninvasive measures.
Provide advanced cardiac life support measures as required.
12. In patients with altered consciousness, a capillary glucose should be performed.
Patients who are hypoglycemic should immediately be given dextrose (25g in adults, 0.5g/kg in
children).
Administer IV naloxone to patients with respiratory depression and signs, symptoms, or a
suggestive of opioid intoxication .
13. The notion that thiamine must be given prior to dextrose to avoid precipitating Wernicke
encephalopathy is unsupported .
Uptake of thiamine into cells is slower than that of dextrose , and withholding dextrose until
administration of thiamine is complete may prove detrimental to those with actual hypoglycemia.
14. Search clothing, wallets, and pocketbooks for pills, pill bottles, or drug-related equipment, but
take care when doing so to avoid a needle stick.
A medical alert bracelet or necklace may provide important history. A more detailed diagnostic
evaluation can then ensue.
A thorough search of the exposure environment should be conducted for pill bottles or a suicide
note, which may provide clues to etiologic agent(s).
Knowledge of drugs prescribed for the patient or the patient's family or friends and to which he
she could have had access may prove important.
15. History — The history, although intuitively the source of the most helpful information for
identifying the etiology of poisoning, is often unreliable when provided by a patient following
intentional ingestion .
16. It is critical to inquire specifically about the use of over-the-counter medications, traditional or
herbal remedies, and dietary supplements
Lastly, drugs of abuse may only be identified by colloquial or slang terms (eg, "ecstasy" for 3,4-
methylenedioxymethamphetamine [MDMA], or "bath salts" for synthetic cathinones)
17. Physical examination — The physical examination of symptomatic poisoned patients may provide
invaluable clues to the agent involved.
The mental status, vital signs, and pupillary examination are the most useful elements and allow
classification of the patient into either a state of physiologic excitation or depression
18. Physiologic excitation
Physiologic excitation (manifested by central nervous system stimulation and increased pulse,
blood pressure, respiratory rate and depth, and temperature) is most commonly caused by
anticholinergic,
sympathomimetic, or
central hallucinogenic agents;
by drug withdrawal states.
19. Physiologic depression
Physiologic depression (manifested by a depressed mental status, blood pressure, pulse,
respiratory rate and depth, and temperature)
is most commonly precipitated by ethanol,
other sedative-hypnotic agents,
opioids,
cholinergic (parasympathomimetic) agents,
sympatholytics, or
toxic alcohols (methanol or ethylene glycol)
20. Mixed physiologic effects
Mixed physiologic effects may occur in polydrug overdoses or following exposure to certain
metabolic poisons (eg, hypoglycemic agents, salicylates, cyanide),
membrane-active agents (eg, volatile inhalants, antiarrhythmic drugs, local anesthetic agents)
heavy metals (eg, iron, arsenic, mercury, lead), or
agents with multiple mechanisms of action (eg, tricyclic antidepressants)
21. Following the initial diagnostic evaluation and stabilization, other physical findings should be
sought to further define a particular toxic syndrome (toxidrome) and to narrow the potential
etiologies of poisoning.
22. Toxidromes
Toxidromes are constellation of symptoms commonly encoutered with certain drug classes
,including anticholinergics ,cholinergics , opioids and sympathomimetics
Evaluation of possible medication poisonings should include basic laboratory studies ,such as a
complete metabolic profile ,to be determine electrolyte imbalances and liver and renal function
23.
24.
25. Toxicokinetics and Toxicodynamics
Toxicokinetics ( Determines the number of molecules that can reach the receptors)
Uptake
Transport
Metabolism and transformation
Sequestration
Excretion
26. Toxicodynamics
Determines the number of receptors that can interact with toxicants
Binding
Interaction
Induction of toxic effects
27.
28. Important Principles of Toxicokinetics
The effect which a drug produces is dependent on
1) The dose
2) The concentration in the target organ
The kinetics of the drug may differ from therapeutic dose to its toxic dose
Toxicokinetics is important in predicting the plasma concentration of the drug
29. Toxicokinetics and Toxicity
Toxicity depends on
Duration and concentration of drug at the portal of entry
The rate and amount (extent) of drug absorbed ,toxicity will be low at slow absorption rates
The distribution of the drug within the body , where most drugs are distributed in highly perfused
organs like brain, liver and kidneys
In some cases,the organ in which the drug is concentrated may not necessarily suffer the
damage
An example is organochlorine compounds concentrated in adipose tissue while the target organ
is brain
30. The efficiency of biotransformation and nature of metabolites ,where in some cases a drug maybe
transformed to more toxic metabolites or a more lipid or water soluble metabolite which affects the
absorption and distribution of the drug .
Eg) paracetamol ,(INH ,dapsone ,hydralazine
The ability of the drug to pass through cell membranes and interaction with cell constituents
Example , some organochlorine affect the DNA
31. The amount and Storage duration of the drug or its metabolites in the tissue .
example Lead in bones is an example
The rate and site of excretion , where the more rapid the excretion less toxicity it will produce
32. Cummulative Toxicity
The state at which repeated administration of a drug may produce effects that are more pronounced
than those produced by the first dose is known as cumulative effectand resultsbinto cumulative toxicity
Anticancer drugs induced cardiotoxicity
Non cardiac pulmonary Edema – methotrexate,cocaine, hhydrochlorothiazide ,iodinated contrast
agents ,opiates , hydrocodone,morphine etc)
Bronchiolitis obliternans organising pneumonia – Acebutolol, Amiodarone , Amphotericin B ,Bleomycin
, carbamazepine
Bronchospasm – Amp B ,Asprin ,Amiodarone ,ACEI , beta blockers
Iron , lead ,mercury ,aluminium ,arsenic – developmental disorders ,degenerative disorders
,haematological disorders
42. Investigations
12 lead Electrocardiogram
Blood glucose , Anion gap plus lactate and osmolal gap
LFT and coagulation profile
Arterial blood gas analysis
Comprehensive Toxicology screen not normally indicated in emergency treatment unless
suspected cases
Urinalysis - ?rhadomyolysis , save sample for toxicological analysis
CXR if pulmonary edema/ aspiration suspected
CT scan brain may be needed to exclude other causes of alterations in conscious level
43. Treatment
Supportive care
Prevention of further exposure
Absorption
Enchancement of toxin elimination
Administration of antidotes
Prevention of reexposure
44. Supportive care
It include support of ABC and vital signs
And also to prevent and treat secondary complications such as aspiration , cerebral and
pulmonary edema ,pneumonia , renal failure ,sepsis ,thromboembolic disease and generalised
organ dysfunction to hypoxemia or shock
45. DECONTAMINATION
A. DECONTAMINATION OF THE SKIN
cleansing with soap and water – used after dermal exposure to organophosphates
Cleansing with acetic acid ( vinegar ) for nicotine
B . DECONTAMINATION OF THE STOMACH
Emesis
Gastric lavage
Activated charcoal
Endoscopic removal
C. DECONTAMINATON OF THE INTESTINES BY WHOLE BOWEL IRRIGATION (WBI)
48. Differential diagnosis
Head trauma( especially ,in the ethanol intoxicated patient)
Stroke / subarachinoid hemoorhage (SAH)
Meningitis
Metabolic abnormalities ( such as hypoglycaemia , hyponatremia , hypoxemia)
Liver disease
Post ictal state
49. Poisoning reporting centres
Toxbase :NHS intranet and internet based information from National poisons information centre
Mims Colour index or TICTAC ( a computer aided tablet and capsule identification system
available to authorised users ,including regional Drug information Centres and Poisons
Information centres to aid pill identification
CMC Vellore Toxicology center