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1.
Acta Paediatr ; 2021 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-34773285

RESUMO

AIM: To evaluate the prevalence of potentially hepatoxic paracetamol ingestion and associated N-acetylcysteine treatment in young children suspected of paracetamol poisoning. METHODS: A retrospective cohort study of children aged 0-6 years suspected of paracetamol poisoning with a related plasma-paracetamol measurement in the Capital Region of Denmark in the period 2010-2017. Data from the clinical laboratory system were linked to data from electronic patient records via the unique identification number given to all Danish residents. RESULTS: Of 297 children included suspected single paracetamol overdoses were present in 281 (95%). Sixty-nine percent were treated with N-acetylcysteine, and the mean treatment period was 20.3 hours (SD 20.8). A maximum of 6 (2%) of the children suspected of single overdose had plasma-paracetamol concentrations that exceeded the recommended treatment thresholds. No cases of severe hepatotoxicity were registered. Adverse events to N-acetylcysteine-treatment were registered in 3 (2%) children including one anaphylactoid reaction (0.5%). CONCLUSION: This study shows that initiating N-acetylcysteine as a "one size fit all" treatment regimen in all children aged 0-6 years with a suspected single paracetamol overdose leads to substantial overtreatment. The data supports that it is feasible to initiate N-acetylcysteine within 10 hours based on an early plasma-paracetamol test.

2.
Sci Rep ; 11(1): 18959, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556789

RESUMO

The COVID-19 pandemic has put massive strains on hospitals, and tools to guide hospital planners in resource allocation during the ebbs and flows of the pandemic are urgently needed. We investigate whether machine learning (ML) can be used for predictions of intensive care requirements a fixed number of days into the future. Retrospective design where health Records from 42,526 SARS-CoV-2 positive patients in Denmark was extracted. Random Forest (RF) models were trained to predict risk of ICU admission and use of mechanical ventilation after n days (n = 1, 2, …, 15). An extended analysis was provided for n = 5 and n = 10. Models predicted n-day risk of ICU admission with an area under the receiver operator characteristic curve (ROC-AUC) between 0.981 and 0.995, and n-day risk of use of ventilation with an ROC-AUC between 0.982 and 0.997. The corresponding n-day forecasting models predicted the needed ICU capacity with a coefficient of determination (R2) between 0.334 and 0.989 and use of ventilation with an R2 between 0.446 and 0.973. The forecasting models performed worst, when forecasting many days into the future (for large n). For n = 5, ICU capacity was predicted with ROC-AUC 0.990 and R2 0.928, and use of ventilator was predicted with ROC-AUC 0.994 and R2 0.854. Random Forest-based modelling can be used for accurate n-day forecasting predictions of ICU resource requirements, when n is not too large.


Assuntos
COVID-19/epidemiologia , Previsões/métodos , Unidades de Terapia Intensiva/tendências , Área Sob a Curva , Biologia Computacional/métodos , Cuidados Críticos/estatística & dados numéricos , Cuidados Críticos/tendências , Dinamarca/epidemiologia , Hospitalização/tendências , Hospitais/tendências , Humanos , Aprendizado de Máquina , Pandemias , Curva ROC , Respiração Artificial/estatística & dados numéricos , Respiração Artificial/tendências , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , SARS-CoV-2/patogenicidade , Ventiladores Mecânicos/tendências
3.
Dan Med J ; 68(5)2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33913417

RESUMO

INTRODUCTION: This study describes the types and health consequences of medication errors in residential facilities for which the Danish Poison Information Center (DPIC) was contacted. METHODS: This study is based on all inquiries made by residential facilities to the DPIC during a 13-month period. Information about inquirers and residents, data related to the medication error, symptoms, risk assessments and recommendations was collected, and a follow-up phone call was made to evaluate the clinical outcomes, preferably within one week. RESULTS: During the study period, the DPIC received 146 inquiries concerning medication errors in residential facilities. Nearly all inquiries concerned excess administration of medication (96%) and often involved medications targeting the nervous system (65%). In 9% of cases, the DPIC recommended hospitalisation. Most medication errors (92%) were considered of "no or minor risk". Administration of medication to the wrong resident is a frequent reason for consulting the DPIC (45%) in cases with medication errors. CONCLUSIONS: In this study, we inventoried the inquiries made to the DPIC about medication errors in residential facilities in Denmark. Most medication errors did not carry a risk of serious health consequences, but continued monitoring is warranted to minimise risk in this vulnerable population. FUNDING: Copenhagen Center for Health Technology (5001105002), Department of Clinical Pharmacology (Bispebjerg Hospital, The Capital Region) (1152871001). TRIAL REGISTRATION: not relevant.


Assuntos
Venenos , Dinamarca/epidemiologia , Humanos , Centros de Informação , Erros de Medicação , Instituições Residenciais
4.
Basic Clin Pharmacol Toxicol ; 128(3): 542-549, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33150720

RESUMO

The Danish Poison Information Centre (DPIC) regularly receives inquiries about nursing home residents who have been exposed to a medication error. The aim of this prospective cohort study was to describe and discuss the types and consequences of these errors. Data were collected from 1 March 2018 to 31 March 2019. Registered data included characteristics of caller and resident, data related to the suspected medication error, risk assessment and recommendation. Consequences and clinical outcomes were assessed by follow-up telephone calls. Over the study period, the DPIC was consulted about 145 medication errors occurring at Danish nursing homes. The median number of substances administered by error was two (interquartile range 1-5). Hospitalization was recommended in 21% of cases. In one-third of the cases where consultation with the DPIC was done with the resident either on his/her way to or in hospital, hospitalization was found unnecessary, and the resident could have stayed in accustomed surroundings for observation. Follow-up demonstrated that very few medication errors had a severe outcome. This prospective study illustrates that consulting with a poison information centre can qualify risk assessment and potentially reduce hospital admissions following medication errors in a nursing home setting.


Assuntos
Centros de Informação , Erros de Medicação , Casas de Saúde , Medição de Risco , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações , Estudos Prospectivos
7.
Ugeskr Laeger ; 182(51)2020 12 14.
Artigo em Dinamarquês | MEDLINE | ID: mdl-33317687

RESUMO

Local anaesthetic systemic toxicity (LAST) gives rise to symptoms from the central nervous and cardiovascular systems. Knowledge about symptoms and risk factors is crucial in preventing LAST. Treatment of severe symptoms should often include vasopressors and sodium bicarbonate. In cardiac arrest the guidelines for advance life support including high-quality cardiopulmonary resuscitation (CPR) should be followed - emphasising prolonged CPR and extracorporeal life support (ECLS) in case of LAST. The conclusion of this review is that intravenous lipid emulsion should only be considered, when other interventions fail, and ECLS is unavailable.


Assuntos
Reanimação Cardiopulmonar , Oxigenação por Membrana Extracorpórea , Parada Cardíaca , Anestésicos Locais/efeitos adversos , Parada Cardíaca/induzido quimicamente , Parada Cardíaca/terapia , Humanos , Bicarbonato de Sódio
8.
Ugeskr Laeger ; 182(12)2020 03 16.
Artigo em Dinamarquês | MEDLINE | ID: mdl-32285771

RESUMO

Loperamide is an over-the-counter anti-diarrhoeal agent. In supratherapeutic doses, loperamide penetrates the blood-brain barrier, exceeds the efflux capacity of P-glycoprotein and binds to central opioid receptors. We report a case of a 33-year-old woman with a history of opioid abuse, who had a long-term excessive daily intake of loperamide in order to achieve a euphoric effect. Cardiac arrhythmias, respiratory depression and death have been reported in relation to excessive loperamide use.


Assuntos
Loperamida , Transtornos Relacionados ao Uso de Opioides , Adulto , Arritmias Cardíacas , Feminino , Humanos , Loperamida/efeitos adversos
9.
Sci Rep ; 10(1): 4095, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32139733

RESUMO

Treatment guidelines for type 2 diabetes (T2D) recommend avoidance of hypoglycemia and less stringent glycemic control in older patients. We examined the relation of glycemic control to glucose-lowering medications use in a cohort of patients aged>80 years with a diagnosis of T2D and a hospital admission in the Capital Region of Denmark in 2012-2016. We extracted data on medication use, diagnoses, and biochemistry from the hospitals' records. We identified 5,172 T2D patients with high degree of co-morbidity and where 17% had an HbA1c in the range recommended for frail, comorbid, older patients with type 2 diabetes (58-75 mmol/mol (7.5-9%)). Half of the patients (n = 2,575) had an HbA1c <48 mmol/mol (<6.5%), and a majority of these (36% of all patients) did not meet the diagnostic criteria for T2D. Of patients treated with one or more glucose-lowering medications (n = 1,758), 20% had HbA1c-values <42 mmol/mol (<6%), and 1% had critically low Hba1c values <30 mmol/mol (<4.9%), In conclusion, among these hospitalized T2D patients, few had an HbA1c within the generally recommended glycemic targets. One third of patients did not meet the diagnostic criteria for T2D, and of the patients who were treated with glucose-lowering medications, one-fifth had HbA1c-values suggesting overtreatment.


Assuntos
Biomarcadores/análise , Glicemia/análise , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobina A Glicada/análise , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/patologia , Feminino , Seguimentos , Humanos , Masculino , Admissão do Paciente/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos
10.
BMJ Open ; 10(3): e034712, 2020 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-32209630

RESUMO

INTRODUCTION: Current pharmacological treatment options for hyperemesis gravidarum have been introduced based on scarce evidence and are often not sufficiently effective. Several case reports suggest that mirtazapine, an antidepressant, may be an effective treatment for hyperemesis gravidarum, but so far there are no controlled trials investigating the potential effect of mirtazapine on hyperemesis gravidarum. The antiemetic ondansetron is currently widely used to treat hyperemesis gravidarum despite sparse evidence of effect in pregnant women. This study aims to investigate the effect of mirtazapine on hyperemesis gravidarum while also providing data on the effect of ondansetron. METHODS AND ANALYSIS: This randomised double-blind placebo-controlled multicentre trial will be conducted in eight Danish hospitals. One hundred and eighty pregnant women referred to secondary care for hyperemesis gravidarum will be randomly allocated to 14-day treatment with either mirtazapine, ondansetron or placebo. Main inclusion criterion will be Pregnancy Unique Quantification of Emesis (PUQE-24) score ≥13 or PUQE-24 score ≥7 if accompanied by weight loss >5% of pre-pregnancy weight or hospitalisation. Participants are eligible regardless of whether other antiemetics, including ondansetron, have been tried. The coprimary outcomes are effects of mirtazapine and ondansetron, respectively, on PUQE-24 score tested hierarchically on day 2 and day 14. Secondary outcomes include, but are not limited to, differences between the three groups in number of daily vomiting episodes, dropout due to treatment failure, use of rescue medication, weight change and side effects. ETHICS AND DISSEMINATION: The trial has been approved by the Regional Committees on Health Research Ethics in the Capital Region of Denmark, the Danish Medicines Agency and the Danish Data Protection Agency. Results will be published in peer-reviewed journals and submitted to relevant conferences. TRIAL REGISTRATION NUMBER: NCT03785691.


Assuntos
Antieméticos , Hiperêmese Gravídica , Mirtazapina , Ondansetron , Antieméticos/uso terapêutico , Feminino , Humanos , Hiperêmese Gravídica/tratamento farmacológico , Mirtazapina/uso terapêutico , Estudos Multicêntricos como Assunto , Ondansetron/uso terapêutico , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários
11.
Clin Toxicol (Phila) ; 58(7): 698-704, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31601129

RESUMO

Context: N-acetylcysteine (NAC) is used worldwide to prevent liver injury after paracetamol overdoses. Anaphylactoid reactions to NAC occur frequently and often lead to treatment interruptions or discontinuations. In Denmark in 2013, the NAC treatment regimen was simplified from a three-bag to a two-bag NAC regimen. Factors of importance for the development of anaphylactoid reaction to this new regimen are poorly explored. Previous studies have suggested a protective effect of high plasma levels of paracetamol on the development of anaphylactoid reactions. Likewise, exposure to antihistamines prior to NAC treatment may protect against these reactions.Methods: This is a retrospective cohort study of patients treated with NAC and with at least one plasma paracetamol sample performed in the Capital Region of Denmark from 2010 to 2017. The primary outcome was the incidence of anaphylactoid reactions to NAC requiring intravenous treatment with antihistamines and/or glucocorticoids. Logistic regression analyses were carried out to identify the risk of developing an anaphylactoid reaction to NAC affected by influencing factors.Results: Of 4315 admissions included in the study, 259 (6.0%) developed an anaphylactoid reaction to NAC. The two-bag regimen (adjusted OR 0.44 [95%CI: 0.32-0.60]), increasing age (adjusted OR 0.84 [95%CI: 0.78-0.90] per 10-year increase) or children <10 years (adjusted OR 0.14 [95%CI: 0.04-0.36]) and antihistamine co-ingestion in overdose (adjusted OR 0.17 [95%CI: 0.02-0.64]) were associated with significantly fewer anaphylactoid reactions. High plasma paracetamol concentrations protected against development of anaphylactoid reactions during the two-bag regimen (adjusted OR 0.59 [95%CI: 0.47-0.71] and three-bag regimen 0.82 [95%CI: 0.72-0.94] per doubling of paracetamol concentration). The effect differed between the two regimens (p = .004 for interaction).Conclusion: In this retrospective cohort, a high peak plasma paracetamol concentration, age, antihistamine co-ingestion and use of the two-bag NAC regimen were associated with fewer anaphylactoid reactions to NAC.


Assuntos
Acetaminofen/envenenamento , Acetilcisteína/efeitos adversos , Anafilaxia/prevenção & controle , Antídotos/efeitos adversos , Antagonistas dos Receptores Histamínicos/administração & dosagem , Acetaminofen/farmacocinética , Acetilcisteína/administração & dosagem , Administração Intravenosa , Adolescente , Adulto , Analgésicos não Narcóticos/farmacocinética , Analgésicos não Narcóticos/envenenamento , Anafilaxia/induzido quimicamente , Antídotos/administração & dosagem , Criança , Estudos de Coortes , Overdose de Drogas/tratamento farmacológico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
Basic Clin Pharmacol Toxicol ; 125(2): 133-141, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30839153

RESUMO

IV iron is indicated in clinical conditions, where rapid anaemia alleviation and repletion of iron stores are required. The acute toxicity of IV iron is ascribed to the presence of labile iron in plasma. Thus, shorter plasma residence time might improve the safety profile, even for compounds holding-on the iron tightly. In this single-centre, open-label, single-dose escalation study, we evaluated the elimination kinetics of ferric bepectate (FBP) compared to those of ferric carboxymaltose (FCM). Thirty-three iron-depleted anaemic patients who had undergone cardiac surgery were included and received 200, 500 or 1500 mg FBP or 500 mg FCM. Plasma drug curves were subjected to model-free analysis. Because saturation kinetics was found, a compartmental model with limited elimination capacity was applied. Urinary iron excretion was also analysed. The initial non-compartmental analysis revealed an increasing AUC/dose ratio for FBP. For both drugs, the central distribution compartment corresponded to plasma volume, and elimination followed Michaelis-Menten saturation kinetics. Maximal elimination rates (Vmax ) were 224 mg/h and 81 mg/h for FBP 500 mg and FCM 500 mg, respectively; drug concentrations at half Vmax (Km ), 99 mg/L and 212 mg/L, respectively; and terminal plasma half-life (T½), 3.05 h and 8.96 h, respectively. Both drugs were equally effective in eliciting an early ferritin rise. Urinary iron excretion was measurable in all patients receiving FCM but not in those receiving FBP, which was well tolerated. Intravenous iron drugs are subject to capacity-limited elimination with different saturation thresholds. Urinary iron excretion can be used as a surrogate for labile plasma iron.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Compostos Férricos/farmacocinética , Ferro/urina , Maltose/análogos & derivados , Idoso , Anemia Ferropriva/sangue , Anemia Ferropriva/urina , Relação Dose-Resposta a Droga , Compostos Férricos/administração & dosagem , Compostos Férricos/efeitos adversos , Humanos , Infusões Intravenosas , Ferro/sangue , Masculino , Maltose/administração & dosagem , Maltose/efeitos adversos , Maltose/farmacocinética , Pessoa de Meia-Idade , Estudos Prospectivos , Eliminação Renal
13.
J Assist Reprod Genet ; 36(5): 889-903, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30877600

RESUMO

PURPOSE: The IGF signaling cascade exerts important regulatory functions in human ovarian folliculogenesis. The scope of this study was to evaluate the transcription profile of insulin-like growth factor (IGF) genes during human ovarian follicle development and to analyze follicle fluid levels of key IGF proteins. METHODS: Gene expression profiling was performed with microarray gene analysis. The analysis was assessed from ovarian follicles and granulosa cells (GCs) obtained from isolated stage-specific human ovarian follicles, including preantral follicles, small antral follicles, and preovulatory follicles. Numerous genes involved in the IGF signaling pathway was evaluated and key genes were validated by qPCR from GCs. Protein levels of various IGF components of human follicular fluid (FF) were measured by ELISA and time-resolved immunofluorometric assays (TRIFMA). RESULTS: The gene expression levels of PAPPA, IGF2, IGF receptors and intracellular IGF-activated genes increased with increasing follicle size. This was especially prominent in the late preovulatory stage where IGF2 expression peaked. Protein levels of intact IGF binding protein-4 decreased significantly in FF from large preovulatory follicles compared with small antral follicles concomitant with higher protein levels of PAPP-A. The IGF modulators IGF-2 receptor, IGFBPs, stanniocalcins, and IGF-2 mRNA binding proteins were all observed to be expressed in the different follicle stages. CONCLUSIONS: This study confirms and highlights the importance of PAPP-A regulating bioactive IGF levels throughout folliculogenesis and especially for the high rate of granulosa cell proliferation and expression of key ovarian hormones important in the last part of the follicular phase of the menstrual cycle.


Assuntos
Líquido Folicular/metabolismo , Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina/genética , Neoplasias/genética , Folículo Ovariano/metabolismo , Transcriptoma , Adulto , Células Cultivadas , Feminino , Células da Granulosa/metabolismo , Humanos , Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina/metabolismo , Neoplasias/patologia , Folículo Ovariano/patologia , Gravidez , Transdução de Sinais , Adulto Jovem
14.
Clin Pharmacol Ther ; 105(4): 1009-1017, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30412277

RESUMO

In a double-blinded, randomized, crossover trial, we investigated the hemodynamic effects of high-dose intravenous lipid emulsion (ILE) with/without metoprolol. Ten healthy volunteers each completed 4 trial days (placebo + ILE; metoprolol + placebo; metoprolol + ILE; placebo + placebo) in random order. Metoprolol was administered as an initial bolus (10 mg), followed by an infusion (50 mg) from 5 to 30 minutes. ILE was administered as a bolus at 12.5 minutes (2.5 mL/kg), followed by a 15-minute infusion (0.25 mL/kg per minute). On metoprolol + ILE days (compared with metoprolol + placebo) after 120 minutes, mean heart rates were significantly higher (difference, 5.5 beats per minute (bpm); 95% confidence interval (CI), 3.0-8.1 bpm; P < 0.001), and average relative cardiac output was higher (difference, 10 percentage points; 95% CI, 5-15 percentage points; P < 0.001). The hemodynamic effect of ILE developed gradually. ILE had no effect on plasma metoprolol or major adverse events. In conclusion, high-dose ILE has relatively marginal and delayed hemodynamic effects that may have limited clinical relevance in the short-term clinical toxicological setting.


Assuntos
Emulsões Gordurosas Intravenosas/administração & dosagem , Hemodinâmica/efeitos dos fármacos , Lipídeos/administração & dosagem , Metoprolol/administração & dosagem , Adulto , Estudos Cross-Over , Método Duplo-Cego , Feminino , Voluntários Saudáveis , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Adulto Jovem
15.
Clin Toxicol (Phila) ; 57(4): 271-281, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30306811

RESUMO

OBJECTIVE: Extended release (ER) tablets/capsules in massive ingestion overdoses are prone to form pharmacobezoars potentially increasing the risk of late-appearing toxic effects and prolonged symptoms. Oral activated charcoal is often sufficient to prevent drug absorption, but in a recent massive ingestion of highly toxic substances, prior orogastric lavage might be considered. The disintegration characteristics of ER preparations in overdose situations is valuable to understand if the time line and course of the intoxication might be prolonged, but information on these characteristics are unavailable. Slow disintegration and/or pharmacobezoar formation, and the large size makes ER preparation impossible to evacuate using a 30F orogastric lavage tube. This study evaluates the disintegration and pharmacobezoar formation of a simulated massive ER tablet ingestion in an in vitro model, using a selection of extended release tablets, with different disintegrating characteristics when present in therapeutic numbers. Furthermore, the sizes of the formed pharmacobezoars were compared with the dimensions of a 30F orogastric lavage tube. METHOD: A standardized model mimicking the physical effects on pharmaceutical preparations in simulated gastric fluid (SGF) was developed and tested on three mono-depot ER tablets (quetiapine/Seroquel®XR 50 mg, paracetamol/Pinex®Retard 500 mg, verapamil/Isoptin®Retard 240 mg), one poly-depot ER tablet (carbamazepine/Tegretol®Retard 200 mg), and one immediate-release tablet (paracetamol/Panodil® 500mg). Thirty tablets were placed in polyamide mesh bags, either together in one bag or in separate bags, immersed in 1 L SGF, and incubated at 37 °C for 48 h. Released drugs were quantified at 0.5-48 h. RESULTS: Visual inspection showed that Seroquel®XR, Pinex®Retard, and Isoptin®Retard tablets formed firm pharmacobezoars stable for more than 4 h and intact fractions remained for up to 24 h. Drug releases were reduced by 53%, 40%, and 31%, respectively, for up to 8 h compared to separated tablets. Light microscopy showed that contact with SGF transformed the coating of Seroquel®XR and Pinex®Retard to a diffusion-controlled swelled gel-layer, and the Isoptin®Retard tablets into a rigid and slow-releasing matrix. Tegretol®Retard disintegrated into microspheres within 30 min, and Panodil® disintegrated within minutes. DISCUSSION: The developed pharmacobezoars of mono-depot ER tablets demonstrated prolonged drug release. Neither the formed pharmacobezoars, nor the single tablets of the tested mono-depot ER preparations, would pass through the lumen of a standard orogastric lavage tube, rendering this modality ineffective for tablet removal in gastrointestinal decontamination.


Assuntos
Bezoares/etiologia , Preparações de Ação Retardada/farmacocinética , Acetaminofen/efeitos adversos , Acetaminofen/química , Acetaminofen/farmacocinética , Carbamazepina/efeitos adversos , Carbamazepina/química , Carbamazepina/farmacocinética , Preparações de Ação Retardada/efeitos adversos , Preparações de Ação Retardada/química , Liberação Controlada de Fármacos , Overdose de Drogas , Suco Gástrico , Humanos , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/química , Fumarato de Quetiapina/farmacocinética , Comprimidos/efeitos adversos , Comprimidos/química , Comprimidos/farmacocinética , Verapamil/efeitos adversos , Verapamil/química , Verapamil/farmacocinética
16.
Ugeskr Laeger ; 180(50)2018 Dec 10.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30547878

RESUMO

Propranolol is often prescribed to younger people with exam-related performance anxiety. Evidence for effect as well as safety is, however, sparse for this non-approved indication. Furthermore, only relatively large pack sizes are available in Denmark. This may spur an unnecessary, permanent overuse and increase the risk of overdosing and poisoning. The aim of this review is to examine the evidence for the effect as well as safety of propranolol for exam-related performance anxiety and to discuss, whether the use of this drug for this unapproved indication is rational.


Assuntos
Antagonistas Adrenérgicos beta , Ansiedade , Propranolol , Antagonistas Adrenérgicos beta/uso terapêutico , Ansiedade/prevenção & controle , Dinamarca , Humanos , Propranolol/uso terapêutico
17.
Ugeskr Laeger ; 180(49)2018 Dec 03.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30520718

RESUMO

Orogastric aspiration (OA) without orogastric lavage has been the traditional gastric emptying method of choice in Denmark; this being based on national historic studies on poisoned patients. The treatment is still observed to be initiated prior to consultations with the Danish poisons information centre. In this review, we present relevant knowledge in the field of OA. The procedure should only be considered in very limited cases and never routinely. Also, an algorithm is presented for its rare use in relation to other more effective gastrointestinal decontamination methods.


Assuntos
Descontaminação , Lavagem Gástrica , Envenenamento , Irrigação Terapêutica , Dinamarca , Humanos , Envenenamento/terapia , Encaminhamento e Consulta
18.
Ugeskr Laeger ; 179(50)2017 Dec 11.
Artigo em Dinamarquês | MEDLINE | ID: mdl-29260701

RESUMO

Gamma-hydroxybutyrate (GHB) is a drug of abuse, for which physical addiction develops quickly. GHB withdrawal can develop into a life-threatening condition and has previously been treated mainly with benzodiazepines. These have not always proven effective, leading to long hospitalizations in intensive care units. Based on successful Dutch treatment results for using GHB to treat GHB withdrawal symptoms, we propose to implement a similar method in Denmark. The method requires an interdisciplinary effort for which The Danish Poison Information Centre should be consulted for expertise.


Assuntos
Oxibato de Sódio/uso terapêutico , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Algoritmos , Benzodiazepinas/uso terapêutico , Esquema de Medicação , Humanos , Oxibato de Sódio/administração & dosagem , Oxibato de Sódio/efeitos adversos , Oxibato de Sódio/farmacologia
19.
Dan Med J ; 64(6)2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28566118

RESUMO

INTRODUCTION: N-benzylmethoxy (NBOMe) is a new class of hallucinogenic designer drugs sold on cheap blotter papers. They are potent 5-hydroxytryptamine-2A-receptor agonists, and since their recent entry into the drug market there have been worldwide reports of severe intoxications and even fatalities. This study reviews suspected NBOMe drug exposures reported to the Danish Poison Information Centre (DPIC). METHODS: Data from the DPIC database were extracted, including all enquiries with NBOMe exposures reported from 1 January 2013 to 30 June 2016. The following data were extracted: age, sex, date of exposure, risk assessment, co-exposures, geography and reported symptoms. RESULTS: A total of 43 cases were identified: one in 2013, five in 2014, 32 in 2015 and five in the first six months of 2016. The mean patient age was 21 years (range: 15-34 years) with 32 (74%) male and 11 (26%) female patients. The patients most frequently presented with hallucinations/psychosis (n = 18), tachycardia (n = 18) and agitation (n = 15). A total of 16 patients were admitted with co-exposures to other drugs such as alcohol (n = 9), cannabis (n = 7), amphetamine (n = 5) cocaine (n = 3), benzodiazepines (n = 1) and 3,4-methylenedioxymethamphetamine (n = 1). The cases were distributed evenly across the entire country with only ten cases having a postal address in one of the three major cities of Denmark. CONCLUSIONS: This study has shown a steep and sudden rise in reported NBOMe exposures in Denmark within 3-4 years. Geographical data demonstrate an even distribution throughout the country. However, our results also suggest that the use has started to decline. FUNDING: none. TRIAL REGISTRATION: This study was approved by the Danish Data Protection Agency. (BFH-2016-070/04985).


Assuntos
Drogas Desenhadas/envenenamento , Alucinógenos/envenenamento , Fenetilaminas/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/epidemiologia , Adolescente , Adulto , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Adulto Jovem
20.
Drugs ; 77(8): 859-883, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28382570

RESUMO

Drug-drug interactions (DDIs) occur commonly and may lead to severe adverse drug reactions if not handled appropriately. Considerable information to support clinical decision making regarding potential DDIs is available in the literature and through various systems providing electronic decision support for healthcare providers. The challenge for the prescribing physician lies in sorting out the evidence and identifying those drugs for which potential interactions are likely to become clinically manifest. P-glycoprotein (P-gp) is a drug transporting protein that is found in the plasma membranes in cells of barrier and elimination organs, and plays a role in drug absorption and excretion. Increasingly, P-gp has been acknowledged as an important player in potential DDIs and a growing body of information on the role of this transporter in DDIs has become available from research and from the drug approval process. This has led to a clear need for a comprehensive review of P-gp-mediated DDIs with a focus on highlighting the drugs that are likely to lead to clinically relevant DDIs. The objective of this review is to provide information for identifying and interpreting evidence of P-gp-mediated DDIs and to suggest a classification for individual drugs based on both in vitro and in vivo evidence (substrates, inhibitors and inducers). Further, various ways of handling potential DDIs in clinical practice are described and exemplified in relation to drugs interfering with P-gp.


Assuntos
Membro 1 da Subfamília B de Cassetes de Ligação de ATP/metabolismo , Anti-Infecciosos/farmacologia , Antineoplásicos/farmacologia , Fármacos do Sistema Nervoso Central/farmacologia , Interações Medicamentosas , Fármacos Gastrointestinais/farmacologia , Fatores Imunológicos/farmacologia , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/antagonistas & inibidores , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/genética , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/metabolismo , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Antineoplásicos/metabolismo , Linhagem Celular , Fármacos do Sistema Nervoso Central/administração & dosagem , Fármacos do Sistema Nervoso Central/efeitos adversos , Fármacos do Sistema Nervoso Central/metabolismo , Citocromo P-450 CYP3A/metabolismo , Inibidores do Citocromo P-450 CYP3A , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/efeitos adversos , Fármacos Gastrointestinais/metabolismo , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/metabolismo
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