Avoiding Life-Threatening Risks

There are two different kinds of life-threatening adverse events associated with drug withdrawal physical risks and emotional risks. The most common physical risks are seizures and blood pressure spikes. The most common emotional risks are violence against self and others and manic or psychotic reactions. 

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The devil you knew is safer than the one you ve just heard about. In the rofecoxib debate, for example, the media rarely attempted to quantify the number of life-threatening gastrointestinal bleeds caused by first generation NSAIDs but avoided by rofecoxib. Instead, the discussion focused entirely on the newly-identified cardiovascular risks. 

Lovastatin (Mevacor/ Altocor) [Antilipemic/HMG-CoA Reductase Inhibitor] Uses Hypercholesterolemia Action HMG-CoA reductase inhibitor Dose 20 mg/d PO w/ PM meal may T at 4-wk intervals to 80 mg/d max or 60 mg ER tab take w/ meals Caution [X, -] Avoid w/ grapefruit juice, gemfibrozil. Contra Active liver Dz Disp Tabs SE HA GI intolerance common promptly report any unexplained muscle pain, tenderness, or weakness (myopathy) Interactions T Effects W/ grapefruit juice T risk of severe myopathy W/ azole antifungals, cyclosporine, erythromycin, gemfibrozil, HMG-CoA inhibitors, niacin T effects OF warfarin >1 effects W/ isradipine, pectin EMS t Risk of photosensitivity Rxns T effects of warfarin concurrent EtOH use t risk of liver tox diltiazem and verapamil can T risk of lovastatin tox OD Unlikely to cause life-threatening Sxs... 

Action HMG-CoA reductase inhibitor Dose 5-40 mg PO daily max 5 mg/d w/cyclosporine, 10 mg/d w/gemfibrozil or CrCl <30 mL/min (avoid Al-/Mg-based antacids for 2 h after) Caution [X, /-] Contra Active Uvct Dz, unej lained t LFT Disp Tabs SE Myalgia, constipation, asthenia, abd pain, N, myopathy, rarely rhabdomyolysis Interactions t Effects OF warfarin t risk of myopathy W/ cyclosporine, fibrates, niacin, statins EMS t Effects of warfarin concurrent EtOH use can t risk of liver tox Asian pts have an t risk of advise effects OD Unlikely to cause life-threatening Sxs... 

The special risk is observed in patients with hepatic or renal impairment. It is not advised to use allopurinol in acute attacks of gout, but it is useful in chronic gout. Excretion of allopurinol and its active metabolite oxypurinol is primarily via the kidneys and therefore the dosage should be reduced if renal function is impaired. The adverse effects have been reported in patients receiving allopurinol with thiazide diuretics, particularly in patients with impaired renal function. The metabolism of azathioprine and mercaptopurine is inhibited by allopurinol and their doses should be reduced to one-quarter to one-third of the usual dose when either of them is given with allopurinol to avoid potentially life-threatening toxicity.27-29... 

AMPHETAMINES MAOIs Risk of severe and life-threatening hypertension. The risk is greatest with non-selective MAOIs MAO is an enzyme that metabolizes dopamine, norepinephrine and other amines Avoid concurrent use... 

Gastric lavage and activated charcoal are considered to be effective decontamination measures, whereas ipecac-induced emesis should be avoided after massive ingestion, because of the risk of seizures. Aggressive use of benzodiazepine is a reasonable first choice to treat associated involuntary movements, tremor, hyperactivity, and agitation. Chlorpromazine or haloperidol can also be used, especially for serious, life-threatening symptoms, including hypertensive crises and severe hyperthermia, and labetalol or sodium nitroprusside are reasonable choices for rapid stabilization of blood pressure. 

With intravenous administration, there is always a risk of damage to veins through mechanical or chemical means. A good cannulation technique is essential to avoid extravasation, tissue damage or the introduction of air into the circulation. Air embolism is a rare but life-threatening complication. Techniques that puncmre the skin can introduce infection through poor aseptic technique or contaminated equipment. Antihistamines and corticosteroids, if needed for adverse reactions, should never be mixed in the same syringe because precipitation would occur. 

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