Propoxyphene pulmonary toxicity

SAFETY PROFILE A human poison by ingesdon. An experimental poison by ingesdon, intraperitoneal, subcutaneous, intravenous, and intramuscular routes. Human systemic effects by ingesdon anorexia, ataxia, chronic pulmonary edema, cyanosis, increased body temperature, jaundice, nausea or vomiting, sleep disturbance. Experimental teratogenic and reproducdve effects. When heated to decomposidon it emits very toxic fumes of HCl and NOx. See also PROPOXYPHENE. 

Acute toxicity with propoxyphene has been reported to cause nausea, vomiting, miosis, confusion, restlessness, somnolence, coma, apnea, seizures, hypotension, arrhythmias, pulmonary edema, and cardiac arrest. 

In patients presenting with propoxyphene toxicity, the airway should be patent and adequate ventilation assured. If the patient has either inadequate ventilation or a poor gag reflex, then the patient may be at risk of subsequent CO2 narcosis, worsening acidosis, and/or aspiration. If necessary, endotracheal tube intubation should be performed. The initial treatment of hypotension consists of intravenous fluids. There should be close monitoring of the patient s pulmonary parameters to ensure that pulmonary edema does not develop as fluids are infused. The patient should be placed on continuous cardiac monitoring with pulse oximetry. Frequent neurological checks should be made. Gastrointestinal decontamination should be considered only after initial supportive care has been provided and airway control has been assured. Activated charcoal (Igkg ) may be administered. 

Propoxyphene is chemically related to methadone but has very low analgesic activity. Propoxyphene causes a small additive analgesic effect when used in combination with aspirin or acetaminophen. Overdosage of propoxyphene results in severe toxicity, including respiratory depression, circulatory collapse, pulmonary edema, and seizures. The answer is (E). 

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