Toxic warning level

IMATINIB ANALGESICS-OPIOIDS May cause t plasma concentrations, with a risk of toxic effects of codeine, dextromethorphan, hydroxycodone, methadone, morphine, oxycodone, pethidine and tramadol Inhibition of CYP2D6-mediated metabolism of these opioids Monitor for clinical efficacy and toxicity. Warn patients to report t drowsiness, malaise or anorexia. Measure amylase and lipase levels if toxicity is suspected. Tramadol causes less respiratory depression than other opiates, but need to monitor BP and blood counts, and advise patients to report wheezing, loss of appetite and fainting attacks. Need to consider 1 dose. Methadone may cause Q-T prolongation the CHM has recommended that patients with heart and liver disease who are on methadone should be carefully monitored for heart conduction abnormalities such as Q-T prolongation on ECG as they may lead to sudden death. Also need to monitor patients on more than 100 mg methadone daily and thus an t in plasma concentrations necessitates close monitoring of cardiac and respiratory function... 

One UK manufacturer warns that drugs affecting electrolyte balance, such as corticosteroids, may alter lithium excretion and should therefore be avoided, but other manufaeturers do not appear to mention this potential interaction. An early study in rats reported increased lithium clearance with methylprednisolone. The available evidence is insufficient to recommend routine monitoring. However, it may be prudent to consider monitoring lithium effects in patients with renal impairment, or other conditions pre-disposing to lithium toxicity, taking levels if early symptoms suggest a potential problem. 

Control, Signaling, and Levels of Detection. We recommend that two levels of detection be provided, a low warning level set at 1/2 TLV (threshold limit value) and a high alarm level set equal to TLV (code-required). If the high level is reached, an alarm is sent to the ECS, a distinct toxic gas evacuation signal must be broadcast locally throughout the area, and the detected gas supply line must be automatically shut off. 

Since diketene is a strong eye irritant even at low levels, it has a strong warning effect. Diketene becomes unbearable before acute toxic levels are reached. Due to the risk of delayed lung edema, a physician should be consulted and the patient monitored carefully after exposure. 

Detection. Many people can detect hydrogen cyanide by odor or taste sensation at the 1 ppm concentration in air, most at 5 ppm, but HCN does not have an offensive odor and a few people cannot smell it even at toxic levels. Anyone planning to work with hydrogen cyanide should be checked with a sniff test employing a known safe concentration. This test should be given periodically. Several chemical detection and warning methods can be employed. The most rehable are modem, electronic monitors based on electrolytes that react with hydrogen cyanide. 

The nature of the hazard considering its degree of toxicity and its warning properties. A release of carbon monoxide provides no warning while a release of some amine nornuilly provides a strong odor at concentrations well below hanuful levels. 

Visual alarms may be required in locations with a high level of background noise. Different alarms may be provided to warn of different emergencies, e.g. a minor fire, a toxic release or an incident requiring complete evacuation. 

Caution Arsine is a flammable and highly toxic gas that does not provide adequate warning of hazardous levels. Inhalation is the major route of arsine exposure, although there is little information about absorption through the skin or toxic effects on the skin or eyes. Contact with liquid arsine may result in frostbite. 

MEK can be recognized at 2 5 ppm by its odor, which is similar to that of acetone but more irritating its warning properties should prevent inadvertent exposure to toxic levels. In determining worker exposure to MEK, end of shift urine levels appear to be the most reliable biological indicator of occupational exposure. ... 

The odor of a-methyl styrene is detectable at 50 ppm the odor and irritant properties provide good warning of toxic levels. 

If significant clinical toxicity is observed, extend leucovohn rescue for an additional 24 hours (total of 14 doses over 84 hours) in subsequent courses of therapy. Impaired methotrexate elimination or inadvertent overdosage Beg n leucovorin rescue as soon as possible after an inadvertent overdosage and within 24 hours of methotrexate administration when there is delayed excretion (see Warnings). Administer leucovorin 10 mg/m IV, IM, or orally every 6 hours until the serum methotrexate level is less than 10 M. In the presence of Gl toxicity, nausea, or vomiting, administer leucovorin parenterally. 

Theophylline should be used only where methods to measure theophylline blood levels are available because it has a narrow therapeutic window, and its therapeutic and toxic effects are related to its blood level. Improvement in pulmonary function is correlated with plasma concentrations in the range of 5-20 mg/L. Anorexia, nausea, vomiting, abdominal discomfort, headache, and anxiety occur at concentrations of 15 mg/L in some patients and become common at concentrations greater than 20 mg/L. Higher levels (more than 40 mg/L) may cause seizures or arrhythmias these may not be preceded by gastrointestinal or neurologic warning symptoms. 

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