APPENDIX
Robert Flanagan, Alison Jones, Robert L Maynard in Antidotes, 2001
Most poisoned patients recover with little more than reassurance and/or supportive care. In more severe cases of poisoning, supportive measures directed particularly at the cardiovascular and respiratory systems may be required. Measures to promote the elimination of drugs or other poisons from the body are not often indicated, and antidotal therapy, if available, is rarely needed except in the treatment of paracetamol (acetaminophen) poisoning. However, the administration of an antidote can be lifesaving in the appropriate circumstances and may also help reduce morbidity and also health care costs by shortening the duration of treatment. Some antidotes suggested for use in the treatment of some common types of poisoning are listed in Appendix 1.
Nonopioid and adjuvant analgesic agents
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2014
This chapter discusses the drugs include the traditional nonopioid analgesics, that is, paracetamol and nonsteroidal antiinflammatory drugs, the inhalational agents nitrous oxide and methoxyflurane, and a large group of drugs commonly called adjuvant analgesic agents or coanalgesics. These were often developed for other indications, but are very useful in the management of pain, including neuropathic pain, and central sensitization. The development of paracetamol started with the discovery of the fever-lowering effect of acetanilide, a finding that resulted in the manufacture of phenacetin by Bayer. Paracetamol should be regarded as the first-line analgesic for mild-to-moderate pain and as a component of multimodal analgesia in the treatment of moderate and severe pain. The analgesic and antiinflammatory properties of the bark of the willow and other plants have been known for centuries. The active ingredient in willow bark is salicin and it was first described in the nineteenth century.
Acetylcysteine
Kerry Layne, Albert Ferro in 100 Cases in Clinical Pharmacology, Therapeutics and Prescribing, 2020
A 24-year-old woman visits hospital reporting that she took a paracetamol overdose 4 h earlier in an attempt to end her life. The patient describes taking 32 × 500 mg paracetamol tablets. She took the tablets all at once, over a 5-min period. She was certain of the time of the overdose, as she checked her phone and sent a text message as she was taking the tablets. She did not take any other medications or any recreational drugs with the paracetamol and did not drink any alcohol at the time. Her past medical history included a diagnosis of depression, for which she was taking sertraline 50 mg OD. She took no other regular medications and had no known drug allergies. She was a postgraduate university student, drank approximately 14 units of alcohol per week and did not use recreational drugs.
A case of accidental neonatal paracetamol overdose with prolonged half-life and measured metabolites
Published in Clinical Toxicology, 2019
Monica Abadier, Anselm Wong, Paul Stathakis, John Singsit, Melanie Pillay, Andis Graudins
Introduction: Limited data exist regarding paracetamol metabolism after overdose in the neonate. We report a case of repeated supratherapeutic overdose in a neonate with paracetamol metabolite concentrations. Case report: A 10-day-old male neonate presented to hospital after repeated supratherapeutic dosing of paracetamol. Paracetamol concentration 19.5 h post-last dose was 381 μmol/L and 236 μmol/L, 9 h later. Initial alanine aminotransferase (ALT) was normal (18 IU/L) and total bilirubin was 262 μmol/L (N
Pharmacokinetic Interactions of Antihepatotoxic Wedelolactone with Paracetamol in Wistar Albino Rats
Published in Pharmaceutical Biology, 2006
B.P.S. Sagar, Rajiv Panwar, Ashwini Goswami, Kuldeep Kadian, Kanchan Tyagi, Manoj Chugh, Sunita Dalal, R. Zafar
Eclipta alba. (Linn.) Hassk. (Asteraceae), popularly known as “bhringraj,” is effective against liver damage caused by various hepatotoxins and is used traditionally in Indian phytoformulations. For enhanced in vitro. production of wedelolactone (W), leaves of aseptically germinated seedlings were cultured on Murashige and Skoog's (MS) medium supplemented with plant growth regulators under controlled and standardized chemical and environmental conditions. The wedelolactone was extracted, isolated, purified, chemically characterized, and quantitatively estimated. Rats were divided into four groups of six animals each and given paracetamol (250 mg/kg, p.o.), paracetamol (250 mg/kg, p.o.) with wedelolactone (100 mg/kg, p.o.), paracetamol (250 mg/kg, p.o.) with plant leaves extract (250 mg/kg, p.o.), paracetamol (250 mg/kg, p.o.) with leaf callus extract (250 mg/kg, p.o.), respectively. Blood samples were collected at 1, 2, 3, 4, and 6 h after drug administration, and plasma paracetamol concentration was determined. Pharmacokinetic studies revealed that concomitant administration of wedelolactone with paracetamol does not affect the bioavailability of paracetamol. There was no change in Cmax between paracetamol and paracetamol with wedelolactone, but the Tmax of paracetamol was 2 h in control animals while administration of wedelolactone and extracts with paracetamol resulted in shifting of Tmax from 2 to 3 h without affecting the area under the curve (AUC). Because wedelolactone does not alter the bioavailability of paracetamol significantly and also shows a hepatoprotective effect, its use may be recommended in prolonged paracetamol therapy or paracetamol toxicity.
Serum paracetamol-protein adducts in ambulatory subjects: Relationship to recent reported paracetamol use
Published in Biomarkers, 2018
Kennon Heard, Victoria E. Anderson, Eric J. Lavonas, Richard C. Dart, Jody L. Green
Context: Serum paracetamol-protein adducts (PPAs) are a novel potential biomarker of paracetamol exposure. The relationship between serum PPA concentrations and reported paracetamol use in ambulatory adults has not been previously described. Materials and methods: This was a cross-sectional study of ambulatory adults. A detailed medication history was obtained from all subjects and subjects were stratified by reported paracetamol use in the 2 weeks prior to enrolment. Serum PPAs were measured in all subjects and correlated with reported dose, time of last ingestion and demographics. Results: We enrolled 230 in the paracetamol exposure arm and 74 in the no exposure arm. 98/230 (42.6%)of subjects who reported paracetamol exposure had PPA detected and 68/74 (91.9%) of subjects who denied paracetamol exposure had no PPA detected. PPA concentrations were positively correlated with total paracetamol dose and with more recent ingestion. Discussion: Detection of serum PPA generally reflects paracetamol exposure histories in ambulatory adults. Concentrations are well correlated with reported dose and time from last dose. Conclusions: Serum PPA can be detected with reported therapeutic use of paracetamol but may not be detected in all patients who report taking paracetamol.
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