Symptoms of Anticholinergic Poisoning Red as a BeetCutaneous flushing Blind as a BatMydriasis and loss of accommodation Dry as a BoneReduced sweating and secretions Full as a FlaskUrinary retention Hot as HadesHyperthermia Tachy as a TrainIncreased heart rate Mad as a HatterDelirium and hallucinations Does this old chestnut of a…
You give naloxone – a lot of naloxone – and the patient still has some CNS and respiratory depression and hypotension. What gives? Fentanyl has almost replaced heroin in recreational drugs, but the creators of such experiences are always trying to improve the high, and perhaps the profits, by including…
"Open the Flood Gates" Since legalization of marijuana for recreational use in Missouri (11/8/22) and start of licensed sales (2/3/23), more Missourians have ready access to a wide variety of cannabis products. These legally-sold marijuana and marijuana-infused products are subject to "seed to sale" state regulations, including mandated 3rd-party lab…
Gabapentin (Neurontin®, others) is FDA-approved for partial-onset seizures, post-herpetic neuralgia, and restless leg syndrome; pregabalin (Lyrica®) for fibromyalgia, various painful neuralgias, and partial-onset seizures. Both have myriad off-label uses including chronic cough, migraine prophylaxis, pruritus, bipolar and anxiety disorders, hot flashes, and therapy of substance abuse disorders. They are also…
Recreational abuse of the spice nutmeg for psychoactive effect has smoldered along, largely under the radar, for over a century. Although it usually keeps a low profile compared to other drugs of abuse and alcohol, it occasionally enjoys a swift rise in popularity, followed by a crash because of its…
The tricyclic antidepressants imipramine (1958) and amitriptyline (1961) were among the first therapeutic agents for depression. These highly effective drugs revolutionized treatment of depression from a purely psychodynamic approach to one that modulated neurochemistry. Six additional tricyclic antidepressants (TCAs) were eventually approved and the entire class became the gold standard…
Since its introduction in 1995, tramadol has become the second most-widely-prescribed opioid analgesic in the US, topped only by combination hydrocodone-acetaminophen. It is most effectively used for chronic, moderate-to-severe pain conditions such as neuropathic pain and osteoarthritis, but it also has a role in acute pain management. In the US,…
According to marketing slogans from the 1920s, lithium "takes the ouch out of the grouch." Back then, it was an ingredient in 7UP® soda and sold as a hangover remedy. Long absent from soda, lithium today is a commonly prescribed mood stabilizer. It is first-line treatment of acute mania and…
Often included in “One Pill Can Kill” lists, sulfonylureas (SU) have the potential for significant toxicity in overdose. These medications were the first orally-active agents to treat Type 2 Diabetes, approved in the late 1950s, but now represent only one class among many newer antidiabetic agents and combination products.
Acetaminophen overdose is very common and if the antidote, n-acetylcysteine, is given within 8 hours it prevents hepatotoxicity in most cases. The revolutionary change in NAC dosing was introduced about 5 years ago, but the complexity of the different concentrations of NAC in each IV bag leads to frequent dosing and administration errors.