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Antihistamines, Decongestants, and Expectorants during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Pseudoephedrine hydrochloride is the most commonly used agent for pregnant women who require a decongestant (Hornby and Abrahams, 1996; Stanley et al., 2019). It is also the most frequently used sympathomimetic in pregnant and non-pregnant individuals, and is typically used as a decongestant. Pseudoephedrine is also part of a combination therapy and combined with different antihistamines in “common cold” or “sinus” medications. Epidemiological studies of more than 1,000 first-trimester human pregnancies exposed to pseudoephedrine indicate no association with congenital anomalies (Aselton et al., 1985; Heinonen et al., 1977; Jick et al., 1981; Rosa, unpublished, Briggs et al., 2021). Among 12,734 malformed newborns, the frequency of birth defects was not increased among 531 infants whose mothers used pseudoephedrine during organogenesis (Yau et al., 2013).
Excited Delirium
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
John C. Hunsaker, Shannon M Crook, Lisa B.E. Shields
In general, ExDS may have a mortality of about 10 per cent. Sympathomimetic agents include substances such as cocaine, methamphetamine, epinephrine and dopamine. There is a subset of ExD-affected people who have sympathomimetic poisoning with malignant hyperthermia sometimes associated with elevated serotonin levels [4]. These cases have a grim prognosis and are at high risk of death regardless of police actions or method of subdual. This correlates well with published observations that mortality is about 67 per cent for those with a temperature above 41.5°C (106.7°F).
The Respiratory System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Treatment of asthma involves the use of sympathomimetic and anticholinergic bronchodilators, methylxanthines (particularly theophylline), anti-allergic agents, and corticosteroids.
An overview of emergency pharmacotherapy for priapism
Published in Expert Opinion on Pharmacotherapy, 2022
Graham A. Bobo, Wael Almajed, Jack Conlon, Rohan A. Morenas, Wayne J.G Hellstrom
The use of intracavernosal sympathomimetic drugs increases the risk of acute hypertension, reflex bradycardia, headaches, palpitations, tachycardia, and other sequelae. Several studies and case reports explored the effects of phenylephrine injections for the treatment of ischemic priapism. One retrospective study conducted in 2018 evaluated the hemodynamic effects of intracavernosal phenylephrine in 74 different patients. This study revealed a statistically significant decrease in heart rate, systolic blood pressure, and diastolic blood pressure after administration of phenylephrine, and they therefore determined phenylephrine as a safe and efficacious treatment for patients presenting with priapism [62]. Though phenylephrine has been demonstrated to be safe in patients, certain risks should be considered prior to administration. Specifically, a case report, which was published in 2019, discussed a case of hypertensive emergency, with subsequent development of intracranial hemorrhage after the administration of phenylephrine for ischemic priapism. The authors hypothesized that the use of beta blockers, in combination with the α stimulation of phenylephrine, led to the hypertensive emergency [63]. Another case report published in 2008 discussed a 23-year-old patient with sickle cell disease who developed an acute subarachnoid hemorrhage after administration of phenylephrine in the setting of ischemic priapism [64]. As demonstrated by these case reports, phenylephrine is an effective treatment for priapism, but caution should be taken prior to administration.
Olanzapine/samidorphan precipitated opioid withdrawal in a patient taking transdermal fentanyl
Published in Clinical Toxicology, 2022
Nicholus M. Warstadt, Zachary P. Schmitz, Samara E. Soghoian
Precipitated opioid withdrawal (POW) is a life-threatening form of opioid withdrawal characterized by the sudden onset of extreme, difficult to control symptoms, with increased potential for pulmonary edema, hemodynamic instability, and death [5]. We inferred a diagnosis of samidorphan POW based on the temporality of the patient’s symptoms following exposure, clinical opiate withdrawal syndrome, lack of likely alternate explanation, and rapid return to baseline [6]. Sympathomimetic toxicity and sedative/hypnotic withdrawal were also considered. There was no evidence of thyrotoxicosis, cardiogenic pulmonary edema, primary neurologic event, or infection on concomitant medical workup. Management of POW is primarily supportive, including fluid replacement, antiemetics, benzodiazepines, and clonidine. Hemodynamic and respiratory monitoring is essential. Intubation and deep sedation are rarely necessary. Naltrexone has been most frequently implicated in POW following administration in acute opioid overdose, rapid opioid detoxification, or after unintentional use [5,7]. Buprenorphine may be helpful in these cases [7]. High potency opioid agonists such as fentanyl may also be helpful to overcome µ-opioid receptor blockade. However, these may be less useful after samidorphan, which has greater receptor affinity [7]. To our knowledge, this is the first case report describing samidorphan POW. With its recent FDA approval as a combination tablet with olanzapine, prescribers should avoid samidorphan in patients taking prescribed or illicit opioids.
Impact of chronic medications in the perioperative period: mechanisms of action and adverse drug effects (Part I)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
A primary concern related to the use of MAOIs is the potential to precipitate an acute hypertensive crisis, or “serotonin syndrome,” with concomitant use of drugs possessing sympathomimetic effects (e.g. meperidine and β-blockers) which stimulate the release of NE from noradrenaline nerve terminals [86,93]. Meperidine and indirect-acting sympathomimetics (e.g. ephedrine) may precipitate potentially fatal acute serotonergic hypertensive crisis and are contraindicated with all MAOIs [86]. Direct-acting sympathomimetics (e.g. adrenaline, noradrenaline, and phenylephrine) are metabolized by catechol-O-methyltransferase and are not-dependent on the MAO enzyme and have a decreased risk for causing a hypertensive crisis. However, doses of these sympathomimetic drugs should still be carefully titrated as they may have an enhanced effect due to receptor hypersensitivity.