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Emergency treatment of poisoning

Emergency treatment of poisoning

These notes provide only an overview of the treatment of poisoning and it is strongly recommended.

Hospital Admission:

All patients who show features of poisoning should generally be admitted to hospital. Patients who have taken poisons with delayed action should also be admitted, even if they appear well. Delayed action poisons include asprine, iron, paracetamol, tricyclic antidepressants, co-phenotrope and paraqual; the effects of modified release preparations are also delayed. A note of all relevant information including what treatment has been given should accompany the patient to hospital.

CENTRAL NERVOUS SYSTEM

CENTRAL NERVOUS SYSTEM

(A)

Hypnotics and anxiolytics:

Following are hypnotics and anxiolytics medicines:

1. Flurazepam
2. Lormetazapam
3. Mirtazapine
4. Nitrazepam
5. Temazepam
6. Zolpidem Tartrate
7. Melatonin
8. Chloral Hydrate
9. Triclofos Sodium
10. Promethazine HCL
11. Alprazolam
12. Bromazepam
13. Captodiamine HCL
14. Chlordiazepoxide
15. Chlordiazepoxide+Clidinium
16. Clorazepate
17. Diazepam
18. Estazolam
19. Lorazepam
20. Nimetazepam
21. Pinazepam
22. Tofisopam
23. Buspirone HCL

Beta Blockers

They do not effect psychological such as worry, tension and fear and they don’t reduce autonomic symptoms as well as non-autonomic symptoms.

1. Meprobamate
2. Phenobarbitone
3. Etifoxine Hydrochloride

CARDIOVASCULAR SYSTEM

CARDIOVASCULAR SYSTEM

2.1 Positive inotripic drugs

Cardiac glycosides

DIGOXIN is the medicine used in Congestive cardiac failure, cardiac dysarrycalcemia, and paroxysmal supraventricular tachycardia.

2.2 Diuretic

Diuretic has been classified:

(a) Loop diuretics:

·        Furosemide

·        Bumetenide

(b) Thiazide diuretics:

·        Chlorthiazide

·        Hydrochlorothiazide

·        Bendrofluazide

(c)  K.Sparing diuretics:

·        Spironolactone

·        Amiloride

·        Triameterene

·        Indapamide

(d) Carbonic anhaydrase inhibitors:

·        Acetazolamide

2.3 Anti-arrhythmic drugs

ANALGESIC AND ANTIPYERTICS

ANALGESIC AND ANTIPYERTICS

Assessment of pain is essential for its correct treatment. As pain is subjective any assessment is best based on the patient’s own verbal report and clinical and analgesic history, to making a physical examination and psychosocial assessment, the patient should be questioned on the severity, quality and site of pain, its frequency and duration, and its effect on lifestyle.

The World Health Organization’s (WHO) analgesic leader ascending from non-opioids through weak opioids who develop mild pains such as tension headaches are:

Mild Pain:

In the mild pain we can use following:

1. Aspirin / Salicyates
2. Paracetamol
3. Dipyron(Metamizole)
4. Ibuprofen
5. Mefenamic Acid

Moderate Pain:

In the moderate pain we can use:

1. Dextropropoxyphene
2. Codeine Phosphate + Paracetamol
3. Nefopam HCL
4. Propyphenazone + caffine

Severe Pain:

In the severe pain we can use:

1.      Buprenorphine

2.      Butorphanol

3.      Codeine Phosphate

4.      Fentanyal Citrate

5.      Nalbuphine HCL

6.      Pentazocine

7.      Morphine Sulphate

8.      Tramadol HCL

9.      Acetaminophen

Anti migraine therapy

Anaesthesia

Anaesthesia

General Anaesthesia is:

1.     Intravenous Anaesthesia

2.     Inhalational Anaesthesia

3.     Antimuscarinic Drugs

4.     Sedative and A Analgesics

5.     Pre-operative Drugs

6.     Muscle Relaxants

7.     Anticholinesterase used in Anaesthesia

8.     Antagonists for central and respiratory depressants

9.     Drugs for malignant hyperthermia

Prescribing in dental practice

Prescribing in dental practice

This section provides guidelines on the management of the more common medical emergencies which may arise in dental practice. Dental surgeons and their staff should be familiar with standard resuscitation procedures, but

Prescribing for the elderly

Prescribing for the elderly

Elderly patients often receive multiple drugs for their multiple diseases. This greatly increases the risk of drug interactions as well as adverse reactions, and may affect compliance. The balance of benefit and harm of some medicines may be altered in the elderly. Therefore elderly patients’ medicines should be reviewed regularly and medicines which are not of benefit should be stopped

Adverse reactions to drugs

Adverse reactions to drugs

Any drug may produce unwanted or unexpected adverse reaction. Detection and recording of these is of vital importance.

Only limited information is available from clinical trails on the safety of new medicines. Further understanding about the safety of medicines depends on the availability of information from routine clinical practice.

Prevention of adverse reactions

Adverse reactions may be prevented as follows.

• Never use any drug unless there is good indication. If the patient is pregnant do not use a drug unless the need for it is imperative.
• Allergy and idiosyncrasy are important causes of adverse drug reactions. Ask if the patient has previous reactions.
•  Ask if the patient is already taking other drugs including self-medication drugs, health supplements, herbal and complementary therapies, interactions may occur.

Prescribing in palliative care

Prescribing in palliative care

Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spintual problems, is paramount to provide the best quality of life for patients and their families. Careful assessment of symptoms and needs of the patient should be undertaken by a multidisciplinary team.

Hospice care of terminally ill patients has shown the importance of symptoms control and psychosocial support of the patient and family. Families should be included in he care of the patient if they wish.

Prescribing for children

Prescribing for children

Children, and particularly neonates, differ from adults in their response to drug. Special care is needed in the neonatal period (first 30 days of life) and doses should always calculate with care. At this age, the risk of toxicity is increased by inefficient renal filtration, relative enzymes deficiencies, differing target organ sensitivity, and inadequate detoxifying systems causing delayed excretion.

Whenever possible, painful intramuscular injections should be avoided in children.

Guidance on prescribing

Guidance on prescribing

General guidance

1. Medicines should be prescribed only when they are necessary.
2. It is important to discuss treatment options carefully with the patient to ensure that the patient is content to take the medicine as prescribed.
3. It is particularly important during pregnancy where the risk to both mother and fetus must be considered.
4. The prescriber and the patient should agree on the health outcomes that the patient desires and on the on the strategy for achieving them.
5. Taking time to explain to the patient and relatives the rationale and the potential adverse effects of treatment may improve compliance.