Doses overdose

GHB is rapidly absorbed from the GI tract and its onset of action is extremely rapid. Loss of consciousness may occur within 15 to 30 minutes. The duration of response is also short, typically 1 to 3 hours for normal dose and 2 to 4 hours with excessive dose. Overdose leading to coma and respiratory depression requiring assisted ventilation generally resolves in <6 hours. Frequent use of GHB in high dose may produce tolerance and dependence despite its short duration of action. A withdrawal syndrome consisting of tremor, agitation, paranoia, delirium, hallucinations, confusion, tachycardia, and hypertension may follow cessation from chronic heavy use. 

Methemoglobinemia is a rare occurrence with nitrate therapy and is characterized by cyanosis, and nausea/vomiting, progressing to shock and coma. This rare adverse effect is usually associated with high doses/overdoses of nitrate products, but can also be seen at normal therapeutic doses. 

Reported cases of vitamin toxicity owing to overdose are usually associated with increased over-the-counter availabiHty of supplemental vitamins and indiscriminate supplementation. The misconception that if a Httle is good a lot is better has compounded toxicological problems with the vitamins. Eat-soluble vitamins tend to accumulate in the body with relatively inactive mechanism for excretion and cause greater toxicological difficulties than do water-soluble vitamins. 

Adverse reactions seen with magnesium administration are rare. If they do occur, they are most likely related to overdose and may include flushing, sweating, hypotension, depressed reflexes, muscle weakness, and circulatory collapse (see Display 58-2). 

Acetaminophen is usually well tolerated, but potentially fatal hepatotoxicity with overdose is well documented. It should be used with caution in patients with liver disease and those who chronically abuse alcohol. Chronic alcohol users (three or more drinks daily) should be warned about an increased risk of liver damage or GI bleeding with acetaminophen. Other individuals do not appear to be at increased risk for GI bleeding. Renal toxicity occurs less frequently than with NSAIDs. 

Monoamine oxidase inhibitors can induce hyperpyrexia anchor seizures or opioid overdose symptoms Used in severe pain Do not use transdermal in acute pain... 

Example In an overdose case where evidence was available for the ingestion of Percodan (a mixture of several common drugs) the isobutane-CI mass spectrum of the gastric extract was obtained (Fig. 7.8). [29] All drugs give rise to an [Mh-H] ion. Due to the low exothermicity of protonation by the tert-C Hi) ion, most [Mh-H]" ions do not show fragmentation. Solely that of aspirin shows intense... 

Antidepressants. The tricyclic antidepressant desipramine has shown some small success in reducing cocaine craving, but the results are not overly impressive, and desipramine has many well-documented side effects and is dangerous in overdose (see Chapter 3 for more information). Cocaine-abusing patients who are not highly motivated will usually not remain adherent to the desipramine prescription. We do not recommend desipramine for the nondepressed cocaine addict. 

Nortriptyline (Pamelor). A recent study suggested that the tricyclic antidepressant nortriptyline, like bupropion, is effective in the treatment of smoking cessation. Nortriptyline does not have any significant effect on dopamine reuptake activity, but it does increase norepinephrine availability. Like bupropion, nortriptyline may therefore reduce the physical symptoms of nicotine withdrawal. Because nortriptyline carries the danger of lethality in overdose and has the unfavorable side effect profile of the tricyclics, we do not recommend its use for smoking cessation. However, it does raise the question as to whether other newer antidepressants that increase norepinephrine activity (e.g., venlafaxine, mirtazapine, duloxetine) may also prove to be effective treatments for nicotine withdrawal. 

When treating insomnia without depression, doxepin and amitriptyline (both tricyclic antidepressants) can be administered in low doses (25-100 mg) at bedtime. These antidepressants, however, do have troublesome anticholinergic side effects (dry mouth, constipation, blurred vision, dizziness) and adverse effects on the heart, and they can be lethal if taken in overdose. Because of their effect on heart function, these antidepressants should be avoided in patients with heart problems and administered cautiously, if at all, to those who are already receiving one of any number of newer antidepressants that inhibit the metabolism of the TCAs. 

The excellent clinical efficacy of the TCAs has been well documented and the pharmacokinetic profiles are favourable. The most serious disadvantage of the TCAs lies in their cardiotoxicity. Thus, with the exception of lofepramine, all the tricyclic antidepressants, including maprotiline, block the fast sodium channels in the heart which can lead to heart block and death. Approximately 15% of all patients with major depression die by suicide and a high proportion of these (up to 25%) do so by taking an overdose of TCAs. Such a dose can be as low as 5-10 times the recommended daily dose. 

Today, as a result of criminal prohibition, heroin is only available on the black market and is commonly adulterated with admixtures that increase the health risks, including the likelihood of overdose." Additionally, under criminal prohibition, most states do not allow heroin users to obtain sterile syringes users are left to re-use syringes and share these with other users. ... 

Suspected benzodiazepine overdose The recommended initial dose is 0.2 mg (2 mL) administered IV over 30 seconds. If the desired level of consciousness is not obtained after waiting 30 seconds, a further dose of 0.3 mg (3 mL) can be administered over another 30 seconds. Further doses of 0.5 mg (5 mL) can be administered over 30 seconds at 1-minute intervals up to a cumulative dose of 3 mg. Most patients with benzodiazepine overdose will respond to a cumulative dose of 1 to 3 mg, and doses beyond 3 mg do not reliably produce additional effects. 

High potency (HP) injection - HP injection is a highly concentrated solution of hydromorphone intended for use in opioid-tolerant patients. Do not confuse HP injection with standard parenteral formulations of injection or other opioids. Overdose and death could result. 

CR/ER/SR tablets/capsules Swallow whole do not break, chew, crush, or dissolve because of the risk of acute overdose. Ingesting chewed or crushed beads or pellets will lead to the rapid release and absorption of a potentially toxic dose of morphine. 

Caution - Opium tincture contains 25 times more morphine than paregoric. Do not confuse opium tincture with paregoric this may lead to an overdose of morphine. 

Children For infants and children especially, an overdose of antihistamines may cause hallucinations, convulsions, or death. Mental alertness may be diminished. In the young child, dimenhydrinate may produce excitation. Do not give to children under 2 years of age unless directed by a physician. 

The recommended initial dose is 0.25 to 0.3 mg/kg/day prepared as 0.1 mg/mL infusion and delivered slowly over 2 to 6 hours. Depending on the patient s cardio-renal status, dosage may be gradually increased by 5 to 10 mg/day up to a total dose of 0.5 to 0.7 mg/kg/day. Some mycoses may require total doses up to 1 to 1.5 mg/kg/day. Do not exceed a total daily dose of 1.5 mg/kg overdoses can result in cardio-respiratory arrest. Alternate daily dosing is recommended for total daily doses of 1.5 mg/kg. 

Forced diuresis is occasionally useful. It may cause volume overload or electrolyte disturbances. Forced diuresis is useful for phenobarbital, bromides, lithium, salicylate, or amphetamines overdoses. Do not use for tricyclic antidepressants, sedative-hypnotics, or highly protein-bound medications. The most common agents employed are furosemide and osmotic diuretics with mannitol. 

Drink at least eight hefty glasses of fluid (preferably water) just prior to the test. Many people start drinking water several days before the test which is useless. Water does not clean any THC metabolites out of your system because THC is not water soluble. Water only dilutes urine temporarily. Do not over do it you can get water intoxication. People can actually overdose and even die from water intoxication. It s very hard to do, and you ll vomit before anything gets serious. 

The evaluation of the contribution on relative efficacy by cathartic agents to the overall management of oral drug overdoses is often difflcult because of limitations of human volunteer studies that do not simulate clinical conditions, because of multiple therapies employed, because the dosage for cathartics used were not comparable, and because the expected theoretical effects were not observed. 

Amphotericin (nonliposomal) - Do not use to treat noninvasive forms of fungal diseases. Exercise caution to prevent inadvertent overdose. 

Combined use of any of the drugs in this category increases the risk of death. While a single drug may not depress respiration markedly, a combination of drugs can do so. The antidote for benzodiazepine overdose is an intravenous injection of Romazi-con (flumazenil). 

While overdoses are uncommon with pure Ecstasy, they do occur. When someone takes too much Ecstasy, he or she may vomit continuously and vigorously, have fast or difficult breathing, or pass out. People with existing heart, kidney, or liver problems are much more likely to suffer from an overdose when taking Ecstasy. 

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