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Biological Effects and Medical Treatment
Published in Alan Perkins, Life and Death Rays, 2021
Once a radiation casualty has been confirmed the options for treatment are limited. In situations where the victim is contaminated with radioactivity it is necessary to remove clothing and wash any external contamination from the skin. If the victim can be treated immediately after the radioactivity has been swallowed, the radiation dose can be limited by removing radioactivity from the stomach, thereby preventing absorption by the small bowel. In the past this was undertaken by gastric lavage and pumping out the stomach contents. It is also possible to induce vomiting by giving an emetic agent that causes gastric irritation and sickness. Emetics such as salt or mustard solution, or syrup of ipecac have been used in the past, but since the administration of emetics can be dangerous, oral dosing of activated charcoal is often used to bind the poison, causing it to pass through the bowel and preventing absorption into the bloodstream.
Breast Feeding
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Perioperative care. Premedicants should be avoided if possible. Benzodi-azepines may safely be given to an anxious breast feeding patient but there is a risk of postoperative drowsiness interfering with the smooth recommencement of a feeding regimen. Anti-emetics should be avoided. Metoclopramide is concentrated in milk by comparison with plasma. There is a theoretical risk of anti-dopaminergic reactions in the infant following ingestion of milk containing such agents.
Principles of systemic treatment
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
The use of specific anti-emetic drugs varies but a simple anti-emetic protocol is as follows: Low potential schedules Metoclopramide 10 mg orally or prochlorperazine 25 mg rectally preceding chemotherapyModerately emetogenic schedules Dexamethasone 8 mg and metoclopramide 10 mg intravenously preceding chemotherapy followed by dexamethasone 2 mg three times daily orally for 2–3 days with metoclopramide 10 mg three times daily orallyHighly emetogenic schedules Dexamethasone 8 mg and ondansetron 8 mg orally or intravenously preceding chemotherapy followed by dexamethasone 4 mg twice daily and ondansetron 8 mg twice daily orally for 2–3 days
Dose ingested, vomiting, and outcome in patients ingesting a standard paraquat 20SL formulation
Published in Clinical Toxicology, 2023
Eileen Deuster, John A. Tomenson, Fahim Mohamed, Indika Gawarammana, Nicholas A. Buckley, Martin F. Wilks, Michael Eddleston
The Food and Agricultural Organization (FAO)’s Committee of Experts on Pesticides in Agriculture (predecessor to the current FAO/WHO Joint Meeting on Pesticide Specifications [JMPS]) subsequently adopted this formulation for its international specifications (Box 1) [8]; it remains the global quality specification for paraquat [9], with some revisions in text [10]. The specifications note that an emetic that causes more than 50% of patients to vomit within 30 min must be included in the formulation; early versions note that only PP796 has been shown to do this (Box 1). Unfortunately, no evidence was provided to support this statement, which has been removed in the most recent version of the specifications [10]. Furthermore, review of the pre-clinical and clinical data suggest that the dose of emetic might be too low to be effective [7].
Evidence for the efficacy of the emetic PP796 in paraquat SL20 formulations – a narrative review of published and unpublished evidence
Published in Clinical Toxicology, 2022
Some data were presented as unpublished data in a 1987 review [15]. It reported that the timing of vomiting and the presence/absence of an emetic could be identified for 61 of 262 patients (40 with emetic, 21 without emetic) (Table 3). Sixty-five percent of patients ingesting emeticised formulations vomited within 30 min vs 19.0% of patients ingesting non-emeticised formulations (p < 0.005 according to the review). However, the number ingesting liquid SL vs granular SG products was not presented (important due to the much lower toxicity and higher PP796:paraquat ratio of the SG products). This article was used by the manufacturers to support claims that the addition of PP796 to paraquat SL20 increased the incidence of early vomiting and made the emeticised paraquat product safer [40,57,58].
Venetoclax as a therapeutic option for the treatment of chronic lymphocytic leukemia: the evidence so far
Published in Expert Opinion on Pharmacotherapy, 2021
Lauren Held, Chloe Siu, Mazyar Shadman
Key considerations prior to initiating venetoclax include assessing TLS risk, appropriate monitoring for neutropenia, and counseling for GI toxicities. Prior to initiating venetoclax, ensure patients are appropriately assessed for risk of TLS and initiate therapy in the inpatient setting if they were deemed high risk for TLS based on package labeling. Blood counts should be monitored throughout treatment, and dose should be interrupted and/or reduced for neutropenia. Growth factor may be considered during periods of neutropenia. GI toxicities with diarrhea and nausea occurred in clinical trials. Ensure patients have anti-emetics at home for as-needed use. Consider diet modifications and use of over-the-counter loperamide for diarrhea development.