Drug Safety
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Acute poisoning with organic solvents and other volatile compounds now usually follows deliberate inhalation (volatile substance abuse) or ingestion of these compounds. Solvents from adhesives, typewriter correction and dry cleaning fluids, cigarette lighter refills (butane) and aerosol propellants are commonly abused. The major risk is that of sudden death. ⋯ In addition, such knowledge is helpful when the clinician is attempting to interpret the results of toxicological analyses performed on samples (blood, other tissues, urine) from such patients. Many volatile substances are partly metabolised, the metabolites being eliminated in exhaled air or in urine. Although metabolism normally results in detoxification, enhanced toxicity may also result as with carbon tetrachloride, chloroform, dichloromethane, n-hexane, trichloroethylene and possibly halothane.(ABSTRACT TRUNCATED AT 400 WORDS)
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Nonsalicylate, nonsteroidal anti-inflammatory drugs (NSAIDs) can be divided into 4 chemical classes: acetic acids, fenamic acids, oxicams and propionic acids. Most NSAID overdoses result in a benign outcome. Of 50,614 exposures reported to poison centres in the United States in a 2-year period, 131 (0.26%) had a major outcome, with 10 deaths. ⋯ However, because the drugs are universally highly protein bound, with little unchanged renal excretion, this technique is not likely to be beneficial. Haemodialysis is also unlikely to enhance elimination, but may be required if oliguric renal failure develops. Multiple dose activated charcoal may be useful in enhancing elimination of NSAIDs with long half-lives, such as piroxicam and sulindac.
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Spinal and epidural blockade are similar in many respects in the anaesthesia they produce, since they both cause major conduction blockade with local anaesthetic agents. Physiologically, the blockade involves the production of a sympathectomy with venous pooling and decreased venous return, causing decreased cardiac output and hypotension. Physiological complications include bradycardia, heart block and, rarely, cardiac arrest. ⋯ Cranial nerve lesions are rarely seen with spinal anaesthesia. This review covers the adverse effects of spinal and epidural blockade and what can be done to prevent and/or treat them. With attention to proper performance and patient selection, spinal and epidural anaesthesia are safe and efficacious options when choosing anaesthetic technique.