National Library of Medicine HSDB Database

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  • December 14, 2016
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First, the steady state was no visible problems, but after 3 years showed disease progression. vivax, in a total of 376 episodes of malaria in the first trimester of pregnancy, in 300 Karen women (Thailand, 1995-2000). The effect was rapid in onset, usually unnoticed (although tinnitus was reported in seven patients), and resolved completely after treatment was completed. The use of the Truven Health Analytics Inc. The most significant toxicity is cardiovascular and includes sinus tachycardia, high-degree atrioventricular heart block, prolongation of the PR interval, sinoatrial block and arrest, ventricular fibrillation, torsade de pointes. Prompt management of methemoglobinemia is essential to avoid potential life-threatening complications. The primary end point of the study was the polymerase chain reaction—corrected cure rate for the per-protocol population.

However, its benefit may not be as large as reported from the pooling of published studies alone. In HIV and TB infected populations, concerns about potential interactions between quinine and antiretroviral and anti-tuberculosis drugs exist, and these will need further research and pharmacovigilance. Malaria is the world’s most important parasitic infection (5). All implied warranties of merchantability and fitness for a particular purpose or use are hereby excluded. Tissue schizonticides for causal prophylaxis: These drugs act on the primary tissue forms of the plasmodia which after growth within the liver, initiate the erythrocytic stage. Clindamycin plus quinine is a potential non-ACT combination recommended by World Health Organization (WHO)[7]. Perimetry and visual evoked potential (VEP) were not done due to non-availability of the investigative modalities.

Clindamycin, usually combined with quinine, had been used extensively in South America and has also proved effective in adults and children with acute malaria in Africa (4–6, 13). Severe cases of thrombocytopenia that are fatal or life threatening have been reported, including cases of HUS/TTP. The Malaria in Pregnancy Library ( is a comprehensive bibliographic database created by the Malaria in Pregnancy Consortium that is updated every 4 months using a standardized protocol to search over 40 sources, including PubMed, Web of Knowledge, and Google Scholar. Quinine has been used less commonly for chloroquine-resistant malaria. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines [19]; no prior protocol for the meta-analysis was developed. B) PHARMACOLOGY: Quinine has anti- and prodysrhythmic effects secondary to inhibition of cardiac sodium and potassium channels. In total, 72 subjects were screened and 63 were enrolled into the study.

Treatment courses are reviewed. The primary endpoint was defined as day 28 parasitological failure in five trials [34, 35, 37, 39, 40], day 28 parasitological cure (polymerase chain reaction [PCR]-corrected) in one trial [36] and day 42 parasitological failure (PCR-corrected) in one trial [38]. For the purposes of this article, complicated malaria refers to any clinical presentation requiring parenteral treatment, whilst severe malaria refers to those patients whose presentation meets the strict WHO case definition of severe disease as indicated in Table 1. Chemoprophylaxis[1] Reinforce that prophylaxis is not absolute, breakthrough infection can occur, and that risk avoidance is still necessary. It also inhibits ATP-sensitive potassium channels in pancreatic beta cells causing insulin release similar to sulfonylureas, resulting in hyperinsulinemia and hypoglycemia. Patients were enrolled in Italy at five sites belonging to the network of the Lombardy Study Group for Research in International Health (Gruppo di Studio sulla Salute Internazionale della Regione Lombardia; SIRL). Patients were then allocated by simple randomization to a 7-day oral treatment regimen: quinine sulfate (10 mg of salt/kg of body weight three times a day; Thai Government Pharmaceutical Organization) either alone (Q7) or in combination with tetracycline (4 mg/kg four times a day; Thai Government Pharmaceutical Organization) (Q7T7) or with clindamycin (5 mg of base/kg four times a day; Dalacin C; Pharmacia & Upjohn Pharmaceuticals) (Q7C7).

E) WITH THERAPEUTIC USE 1) At therapeutic doses, patients often complain of skin changes, gastrointestinal upset, and various subtle neurological complaints, including headache, vision changes, hypoglycemia and alteration in hearing. Quinine-induced thrombocytopenia appears to be immune mediated, may be life threatening, and usually resolves within a week of discontinuation. They were also given an instruction sheet describing the exercise programme and confirming the advice. Immune-mediated pancytopenia and coagulopathy may occur at therapeutic doses of quinine. If I try to sleep next to my room without noise I hear and what really bugs. Contact dermatitis may occur following topical administration. However, normal arteriovenous transit times and arteriolar perfusion were demonstrated by fluorescein angiography ().

A Neuromonics device is used like an iPod, with customized sound and music to desensitize the patient to the perception of subjective tinnitus. Our systematic review of the literature identified two additional studies presenting data on artesunate to treat severe malaria in pregnancy [9, 52]. Cardiac toxicity resembles toxicity secondary to quinidine. Two women who had received artemether injections in the first trimester miscarried while receiving a quinine infusion for a subsequent malaria attack (20 weeks and 22 weeks) [24]. Patients complain of blurred vision, tunnel vision, visual field constriction, diplopia, alteration in color perception, photophobia, scotomata, and frank blindness. Respiratory depression may occur. Other causes of tinnitus are drugs such as aspirin (if overused), aminoglycoside antibiotics (a powerful form of drugs that fight infection) and quinine.

0.2.4 HEENT A) WITH POISONING/EXPOSURE 1) Decreased visual acuity and visual field constriction may progress to sudden blindness with nonreactive, dilated pupils following quinine overdose. 2) Fixed dilated pupils are seen frequently in children following quinine overdose. 3) Tinnitus and concentration-dependent hearing impairment are frequent. 0.2.5 CARDIOVASCULAR A) WITH POISONING/EXPOSURE 1) Sinoatrial, atrioventricular, and His-ventricular conduction delays may occur resulting in significant QRS and QT interval prolongation, PR prolongation, ST depression and T wave inversion on ECG. Certain exclusions apply to both regimens; these special populations, pregnant women, lactating women, children weighing less than 5 kilograms and persons with other contraindications, should have diagnostic testing first, and if positive, receive directed treatment. Primaquine—the only drug effective against liver stages—is contraindicated in pregnant women because fetal red blood cells are susceptible to hemolysis [63]. 2) Hypotension occurs frequently following severe overdose.

Heart failure may result. 3) ONSET: Cardiotoxicity typically appears within 8 hours following ingestion of quinine. 0.2.20 REPRODUCTIVE A) Quinine is classified as FDA pregnancy category C. Usually it is permanent but in the case of aspirin and quinine, can be reversible. Numerous malformations and fetal anomalies have been reported in humans and animals. Few, if any, work, and some are harmful. A) Specific laboratory studies for confirming quinine ingestion are not readily available in most clinical laboratories, and are not generally useful for guiding therapy.

B) Monitor serum electrolytes, BUN, creatinine, glucose, CBC, CPK, urinalysis, and ECG. C) In the acutely ill patient, blood gas analysis may demonstrate metabolic acidosis. He had a chest tube was then but because she did not. Low cholesterol diet therapy and anti lipids in the treatment of patients with tinnitus and hearing loss and noise-induced hearing loss hyperlipidemia. B) THERAPEUTIC DOSE: ADULTS: 648 mg orally every 8 hours for 7 days. W. prescription tinnitus deafness, headache nausea, blurred vision .

maybe it does affect a calming effect on the nerves in the auditory system. Factors affecting transplacental DNA damage were examined. Timed pregnant mice or monkeys were given a single dose of carcinogen on different gestation days, sacrificed 1-50 days later, and analyzed for DNA adducts by the (32)P postlabeling assay. These are common in doses > 5 g in adults, and our series confirms this cut-off with > 30% of patients reporting ingestion of these amounts having ECG changes. In the mice, 4-nitroquinoline 1-oxide bound to fetal DNA at low levels, without organotropism (in contrast to maternal tissues), and without a gestation stage dependency. Queries and minor notes: then and now. The ontogenesis of benzo(a)pyrene DNA adduct levels exhibited organ specificity.

Safrole preferentially bound to fetal liver (as for adults) with strong gestation stage specificity. (2) The maternal and fetal Ah genotype affects the types and amounts of 3-methylcholanthrene DNA adducts in the mothers, placenta and fetuses. (3) Benzo(a)pyrene produces the same type and comparable amounts of adducts in fetal monkeys and mice during gestation. (4) Benzo(a)pyrene adducts persist in fetal mouse embryos and monkey tissues for at least 1/3 of gestation. (5) All carcinogens tested bound ubiquitously to all fetal and possible embryonic, DNA with levels exhibiting little relationship to placental levels. (6) Fetal adduct levels varied from 0.05-2 fold of maternal levels depending on the carcinogen tested. Thus, fetal competence in metabolism of a specific carcinogen is a determining factor for transplacental DNA damage.

Placental adduct levels are a qualitative, but not a quantitative, indicator of fetal exposure. Panisko DM, Keystone JS; Treatment of Malaria–1990. Drugs 39S (Feb): 160-89 (1990). A review of the treatment of malaria is presented, including the chemistry, pharmacokinetics, mechanisms of action, resistance, and toxicity of quinine. The distribution of malaria and patterns of resistance are examined.

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National Library of Medicine HSDB Database

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  • October 22, 2016
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It is possible that some side effects of nitroglycerin may not have been reported. products is intended as an educational aid only. not long before I got tossed out of sleep with a blaring T in my left ear and a racing heartbeat beyond sanity. Between January 2004 and October 2012, 10 individuals taking STILNOX reported TINNITUS to the FDA. Accidentally Aspirin poisoning can occur if these drugs are administrated concomitantly, and inappropriate doses are taken for a long time. Clinical studies have shown that a microbiological report indicating in vitro drug resistance does not necessarily preclude a clinical benefit for the patient. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof.

These products are provided “as is” and “as available” for use, without warranties of any kind, either express or implied. Information on our balance system. It was a massive overdose of more than 30 Clomethiazole tablets (used to manage alcohol withdrawal) that ended his life on September 7, 1978 at the age of 32. makes no representation or warranties as to the opinions or other service or data you may access, download or use as a result of use of the Truven Health ANALYTICS INC. products. 1 mg of protamine sulfate for every 100U of heparin overdose. Truven Health Analytics Inc.

The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. products. 0.2.1 SUMMARY OF EXPOSURE ACUTE EXPOSURE A) SOURCES: Found primarily in tobacco-containing products such as cigarettes, cigars, pipe tobacco, and chewing tobacco and also in nicotine replacement products such as gum, nasal sprays, patches, and electronic cigarettes. This is not a complete list of side effects and others may occur. If you do not, the symptoms will get progressively worse.5. B) PHARMACOLOGY: Binds to nicotinic acetylcholine receptors that are found throughout the body, most notably in the autonomic nervous system (preganglionic sympathetic synapses and pre- and postganglionic parasympathetic synapses). C) TOXICOLOGY: Toxic effects are dose-related and result from overstimulation of nicotinic receptors, often causing inhibition of receptor action following initial stimulatory effects.

D) EPIDEMIOLOGY: Very common exposure that can rarely result in significant morbidity and death, especially in children. Symptoms may include uneven heartbeats, seizure (convulsions), slowed breathing, coma, or respiratory failure (breathing stops). Apnea and neuromuscular blockade may occur when aminoglycosides are given rapidly IV with neuromuscular blocking agents, due to aminoglycosides’ inhibition of acetylcholine release from presynaptic nerve terminals; patients with abnormal neuromuscular junction function (eg, myasthenia gravis, botulism) can develop respiratory failure or weakness after use of aminoglycosides alone. Absorption may occur after ingestion, inhalation, dermal, or rectal exposure. F) WITH POISONING/EXPOSURE 1) MILD TO MODERATE TOXICITY: GI upset, nausea, vomiting, dizziness, headache, tremor, diaphoresis, tachycardia, pallor, and hypertension are common events. Withdrawal signs/symptoms have consisted of insomnia, vivid dreams, nausea, diarrhea, abdominal pain, anxiety and palpitations. After some more hours finally the screaming got softer, and softer, and softer, and softer to a point where I almost had silence.

Respiratory stimulation is one of the principal signs of nicotine poisoning. High doses can produce fatal respiratory depression of both central and peripheral origin. Bronchospasm should be treated as medically appropriate. 0.2.20 REPRODUCTIVE HAZARDS A) Nicotine is a possible human teratogen. B) Nicotine is teratogenic in mice, but not in several other species. loss of high frequency hearing can be difficult for patients, as self-diagnose. It has reduced fertility in male and female rats.

0.2.21 CARCINOGENICITY IARC CATEGORY A) IARC Carcinogenicity Ratings for CAS54-11-5 (International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004): 1) Not Listed HUMAN OVERVIEW A) Use of smokeless tobacco has been shown to cause oral-pharyngeal cancer. ANIMAL OVERVIEW A) A correlation between the use of nicotine-containing sheep dip and esophageal tumors has been noted in sheep. 0.2.22 GENOTOXICITY A) DNA inhibition, mutagenicity, and chromosome aberrations have been demonstrated experimentally. A) No testing is required in patients with mild or no symptoms. B) Serum chemistries, creatine kinase, lactate, urinalysis should be performed in patients with severe poisonings. C) Obtain an ECG and institute continuous cardiac monitoring in all symptomatic patients. D) Serum levels are not readily available or useful to guide management.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. 0.4.2 ORAL EXPOSURE A) MILD TO MODERATE TOXICITY 1) Treatment is primarily supportive and symptomatic. Vomiting is common, which tends to limit absorption. Intravenous fluids can be administered. Persistent vital sign abnormalities, altered mental status, muscle weakness, and seizures indicate a more severe poisoning. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Volumes of distribution range from 0.2 to 0.4 L/kg; renally eliminated.

Atropine can be given for bradycardia or significant muscarinic signs (ie, bronchorrhea), if present. Hypotension should be treated with intravenous fluids and then a vasopressor as needed. 0.2.10 GENITOURINARY ACUTE EXPOSURE A) WITH THERAPEUTIC USE 1) Priapism has been noted in many instances after therapeutic doses. Death is primarily from respiratory failure. C) DECONTAMINATION 1) PREHOSPITAL: Prehospital decontamination is unlikely to be of benefit as nicotine is rapidly absorbed and most patients with more than mild toxicity will have significant vomiting. Remove transdermal patches and wash skin. There are no adequate data from the use of tobramycin administered by inhalation in pregnant women.

Gastric decontamination is usually not necessary because patients often present with large amounts of vomiting. If the patient is not already vomiting, consider using activated charcoal and whole bowel irrigation following ingestion of a patch product in a child or ingestion of multiple patches by an adult. Most children born with hearing loss can be diagnosed by a hearing test. E) ANTIDOTE 1) There is no specific antidote. F) ENHANCED ELIMINATION 1) Enhanced elimination is rarely necessary as life threatening toxicity is rare. Multiple dose activated charcoal may be theoretically be beneficial in improving elimination by interrupting enterohepatic circulation, but it is rarely indicated and its use in this setting has not been described. Hemodialysis and hemoperfusion should be effective as nicotine has a small volume of distribution and low protein binding, but they are rarely if ever indicated and their use has not been described.

The vast majority of patients do well with supportive care. G) PATIENT DISPOSITION 1) HOME CRITERIA: Anyone with an intentional ingestion, symptoms other than vomiting, or children who have ingested more than 1 cigarette or 3 or more cigarette butts should be evaluated in a healthcare facility. 2) OBSERVATION CRITERIA: Patients who are asymptomatic after 4 to 6 hours following an oral ingestion of a non-patch product can be discharged. The appropriate duration of observation following ingestion of a patch by a child is not known, but these products contain enough nicotine to cause severe toxicity and may have very delayed absorption; therefore, prolonged observation (24 hours) is recommended in these cases. 3) ADMISSION CRITERIA: Patients with persistent vital sign abnormalities, seizures, altered mental status, or muscle weakness should be admitted. 4) CONSULT CRITERIA: Consult a poison center or medical toxicologist for assistance in managing severe poisonings or following ingestion of nicotine replacement products by a child. H) PITFALLS 1) Urine acidification (while theoretically helpful in enhancing elimination) is not recommended.

Failure to adequately observe a patient who ingests a patch product. Avoid using a H2 blocker or proton pump inhibitor initially because nicotine will be absorbed more easily in an alkaline environment. I) PHARMACOKINETICS 1) Volume of distribution is small at about 1 L/kg and protein binding is limited (about 5%). The half-life at therapeutic doses is about 1 to 2 hours. Peak concentrations are achieved within 0.5 to 2 hours with therapeutic doses. However, absorption may vary significantly by the nicotine delivery system: nasal spray (1 mg dose rises rapidly and can reach maximum venous concentrations of 2 to 12 ng/mL in 4 to 15 minutes) or nicotine inhaler (following a single inhalation the arterial nicotine rises slowly and does not reach the level of smoking a cigarette). Gastric lavage is not warranted because a trazodone ingestion is not life-threatening.

J) TOXICOKINETICS 1) Symptoms typically develop within 30 minutes to 2 hours after an oral exposure. Symptoms may be immediate after inhalational exposure. Symptoms may be delayed after ingestion of patch products. Established susceptibility breakpoints for parenteral administration of tobramycin are inappropriate in the aerosolised administration of the medicinal product.Cystic fibrosis (CF) sputum exhibits an inhibitory action on the local biological activity of nebulised aminoglycosides. 0.4.3 INHALATION EXPOSURE A) INHALATION: Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis.

Administer oxygen and assist ventilation as required. Treat bronchospasm with an inhaled beta2-adrenergic agonist. Consider systemic corticosteroids in patients with significant bronchospasm. 0.4.4 EYE EXPOSURE A) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility. 0.4.5 DERMAL EXPOSURE A) OVERVIEW 1) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown.

A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999). A) TOXICITY: The toxic dose will vary depending on whether the patient is habituated to the effects of nicotine. CIGARETTES: A regular cigarette may contain 13 to 30 mg of nicotine; a low-nicotine cigarette contains approximately half the nicotine; a cigarette butt may contain 3.75 to 5 mg of nicotine. As little as 1 cigarette or 3 cigarette butts have caused symptoms in children. Signs and symptoms of toxicity appear to correlate with the amount of nicotine ingested. Although an oral lethal dose has not been established, an estimated 40 to 60 mg of nicotine may be lethal. In one series, severe toxicity was reported in 3 children ingesting 1.4 to 1.9 mg/kg of nicotine; children ingesting a mean of 0.8 mg/kg developed mild symptoms and children ingesting a mean of 0.5 mg/kg remained asymptomatic.

LIQUID NICOTINE: Refill cartridges used in electronic-cigarettes are available in various strengths ranging from 6 mg/mL (0.6%) to 36 mg/mL (3.6%). It is estimated that 20 drops are equal to 1 mL of solution; 1 drop of 3.6% liquid contains 1.8 mg of nicotine. A potential ingestion of 1 to 2 drops of 3.6% solution (1.8 to 3.6 mg) could produce significant symptoms in a young child. 3) ADMISSION CRITERIA: Patients with cardiac toxicity, persistent hypotension, seizures, or with CNS depression that persists after 12 hours of observation should be admitted. TRANSDERMAL (PATCH): Typically placed for 16 to 24 hours daily and then replaced. NASAL SPRAY: 1 spray (0.5 mg) per nostril every 1 to 2 times per hour. The doses for these products are individualized for the patient, and may vary depending on the degree of habituation.

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