The Use of Medicines for Illness
Richard Blum, Andrew Herxheimer, Catherine Stenzl, Jasper Woodcock in Pharmaceuticals and Health Policy, 1981
Medicines cure illness much less commonly than many people believe, if cure is defined as the restoration of health. The main types of medicines which can do this are antimicrobial and antiparasitic drugs, anti-cancer drugs, and antidotes to poisons. It is easy to see how a drug which attacks a microbe can enable the patient’s own defences to rid the body of the infection, and similarly with parasites and cancer cells. With an antidote to a poison, the process is somewhat different. An antidote may work by inactivating the poison or by accelerating its removal from the body. Or it may antagonise the poison at its site of action: it may either block its access to the point of action or it may have an opposing effect. Preferably the effect of an antidote should last as long or longer than the effect of the poison, otherwise any improvement in the patient will be only transient, so that repeated doses of the antidote have to be given. This is the case when naloxone is used to treat morphine poisoning.
Drug Overdoses during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Nalmefene is an opiate antagonist with an 11-hour half-life, and has potential benefits over naloxone (Kaplan and Marx, 1993). Naloxone has a shorter half-life (one to two hours). Nalmefene is longer acting, and period of withdrawal is longer and less abrupt in opioid-dependent patients (Kaplan and Marx, 1993). Overdose of other non-opioid constituents (e.g., acetaminophen) must be considered in formulating the antidote regimen and treatment plan. For opioid preparations that contain acetaminophen, serious hepatic and renal toxicities require immediate attention. Use of the acetaminophen antidote (NAC) should be given as soon as possible after toxicology documents toxic serum levels. Half-life in the post-absorptive period for morphine is 1.3–6.7 hours, and for codeine, 1.9–3.9 hours; oxycodone, 4.0–5.0 hours; and hydromorphone, 1.5–3.8 hours. Opioid analgesics are ultimately excreted (Baselt, 2017).
Therapeutic Monitoring of Adverse Drug Reactions (ADRs)
Frank A. Barile in Barile’s Clinical Toxicology, 2019
5. Administration of an antidote. As noted earlier, adherence to the ABC principles and good supportive care are the hallmarks of treatment of the poisoned patient. Once the agent responsible is suspected or identified, the administration of an antidote may be necessary. Table 3.11 organizes a variety of toxins according to their classification and available antidotes. Although only a small number of antidotes are available, many of these agents can completely reverse the toxicologic consequences of poisoning. Also, specific antidotes are discussed further under the individual chapter headings (chelating agents for metal poisoning are reviewed separately in Chapter 24, Metals). However, it should be noted that antidotes are associated with their own adverse reactions and toxicity. In addition, the effectiveness of antidotes is compromised in the presence of overdose from multiple agents.
Mass spectrometry in emergency toxicology: Current state and future applications
Published in Critical Reviews in Clinical Laboratory Sciences, 2019
Xander M. R. Van Wijk, Robert Goodnough, Jennifer M. Colby
Emergency toxicology does just this, and is centered around the diagnosis and management of the critically poisoned patient. Care of poisoned patients often starts with the “ABCs” of resuscitation (airway, breathing, and circulation), vital signs, and, where possible, identification of a specific toxic syndrome (toxidrome) [3,4]. Treatment is largely supportive and may include measures to limit absorption of the poison, e.g. gastric emptying or use of activated charcoal, or to enhance excretion, e.g. urine alkalization in salicylate overdose or hemodialysis [4]. Some poisons have specific antidotes that can be administered. For example, naloxone can be used to reverse an opioid overdose. Of note, naloxone use reported to US poison centers has almost tripled from 2000 to 2016 [5]. Other well-known examples of specific antidotes are N-acetylcysteine for acetaminophen and digoxin-specific antibody fragments for digoxin and other cardiac glycosides [4].
Design, characterization and comparison of transdermal delivery of colchicine via borneol-chemically-modified and borneol-physically-modified ethosome
Published in Drug Delivery, 2019
Yujia Zhang, Nan Zhang, Hui Song, He Li, Jin Wen, Xiaochuan Tan, Wensheng Zheng
Gout is a kind of joint disease characterized by the accumulation of monosodium urate (MSU) crystals in the joint and its surrounding tissue, causing persistent hyperuricemia (Ryszard et al., 2016). The acute gout attack is an acute inflammation caused by the disorder of purine metabolism and rising of hematuria acid by some influential factors (Pascual & Sivera, 2007). Severe pain and frequent attacks at night cause substantial adverse effects on patients’ lives. In the acute gout attack, the treatment mainly includes analgesic, and the commonly used drugs are nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, glucocorticoids, and IL-1 antagonist. Colchicine is a classic drug used for the treatment of acute gouty arthritis in 1945. But colchicine remains more toxic in the treatment of acute gout attack, and its clinical adverse reactions mainly include gastrointestinal symptoms such as spastic abdominal pain, diarrhea, nausea, and vomiting. There is no effective antidote as the amount of poisoning is very close to the amount of treatment (Mehmood et al., 2016).
Nrf2 participates in mechanisms for reducing the toxicity and enhancing the antitumour effect of Radix Tripterygium wilfordii to S180-bearing mice by herbal-processing technology
Published in Pharmaceutical Biology, 2019
Jun-Ming Wang, Jin-Yang Li, Hong Cai, Rong-Xing Chen, Yue-Yue Zhang, Lu-Lu Zhang, Ying Cui, Yong-Xian Cheng
In fact, studies have shown that JYH, BS, JQC, GC and LD and the main active extracts and compounds they contain have hepatoprotective and (or) kidney-protective effects (Sohn et al. 2003; Sun et al. 2008, 2010; Wang et al. 2012d; Liu et al. 2015; Yagmurca et al. 2015; Jung et al. 2016; Wang et al. 2016c; Xin et al. 2016; Xie et al. 2018; Ye et al. 2017). Therefore, the processed detoxification of the above five medicinal herbs on LGT-induced hepatotoxicity and nephrotoxicity is not only related to TCM theoretical support belong to them such as sweet and slow detoxification, antidote poisoning by the sweetness of the five flavours, mutual detoxification of seven emotions and so on, but also may be related to their bioactive properties of hepatoprotection and (or) renal protection. In addition, the TP content in the above five processed products decreased by 89.1, 81.9, 91.3, 65.7 and 85.0%, respectively, and the CEL content decreased by 84.8, 89.8, 96.3, 94.3 and 87.0%, respectively. The results suggested that the content of TP and CEL after processing was obviously reduced, which could be another important factor in reducing toxicity. In addition, both TP and CEL contents in JQC-processed product decreased the most than the other four processed products, which can probably explain to some extent why the JQC-processed product group had relatively lower levels of serum ALT, AST, Cr and BUN than the other four processed groups in this study. This may be further explained why JQC had a relatively better detoxification effect on hepatotoxicity and nephrotoxicity caused by LGT in this study.