Misuse and Abuse of drugs
there needs to be child resistant closures on loperamide if it contains more than ___mg
0.045mg
what is the normal dose of tetrahydrozoline?
1-2 drops applied to the eyes/nose
what is the poison control number?
1-800-222-1222
80% of children tested should not be able to open the package within ____ minutes
10 minutes
what is the normal dose of ephedrine?
120 mg daily
what is the normal dose of dextromethorphan?
120 mg in divided doses
what is the abused dose of ephedrine?
1450 mg daily
there needs to be child resistant closures on minoxidil if it contains over ___ mg.
14mg
what is the onset for abuse of tetrahydrozoline?
15-30 minutes and the effects reside within 24 hours
there needs to be child reisistant closures on medication for ibuprofen if it contains over ___g of ibuprofen
1g
there needs to be child resistant closures on medication for acetaminophen if it contains over _____g of acetaminophen
1g
what is the usual dose of activated charcoal?
1g/kg
what is the poison control center?
24 hour sources of: poison information clinical toxicology consultation poison prevention education
what is the normal dose for a first generation antihistamine?
25-50mg every 4-6 hours
there needs to be child resistant closures on elemental iron and naproxen if they contain over ___mg.
250mg
what is the abused dose of first generation antihistamines?
3-5x usual dose
90% of adults must be able to open the package within ___ minutes
5 minutes
there needs to be child resistant closures on medication for diphenhydramine if it contains over ___mg of diphenhydramine
66mg
what is the abused dose of loperamide?
70-100mg daily
what is the normal dose of loperamide?
8mg (self care) 16 mg(Rx)
what are some risks associated with abusing tetrahydrozoline?
CNS depression muscle weakness decreased heart rate decreased blood pressure
at very high doses loperamide can combine with two CYP enzymes to decrease the metabolism, what are they?
CYP3A4 CYP2C8
who should not use activated charcoal?
GI tract is not functionally or anatomically intact bariatric surgery may require dose adjustments high risk of aspiration if the toxin does not absorb the charcoal
what is the brand name for loperamide?
Imodium
what are exemptions to child resistant packaging?
OTC brands may package one size with non child resistant packaging if there are expected products they must explicitly state: "package not child resistant" individuals may request prescriptions that are not placed in child resistant packaging
what is the mechanism of abuse for dextromethorphan similar too?
PCP, ketamine "special K"
what is tetrahydrozoline abused for?
abused for potential to impair another individual
which OTC medication is the leading cause of poisoning?
acetaminophen
pharmacologic options for poisonings?
activated charcoal -absorbent ipecac syrup -emetic - should avoid this as it does not improve outcomes
what are some common RX products that can cause poisonings?
analgesics cough/cold topical preparations vitamins antihistamines
who can call the poison control center?
anyone! it is available for the public and healthcare provider consultation
what is the mechanism of abuse for dextromethrophan?
blocks NMDA receptor in the brain
what risks are associated with misusing/abusing loperamide?
cardiac arrest QT prolongation syncope cardiac arrhythmias
what is QT prolongation?
cardiac issue that could lead to death
what are barriers pharmacist can face when preventing the misuse/abuse of medication?
challenges in identifying drug related problems lack of widespread tracking or tracking between pharmacies
almost half of drug poisonings are in what age?
children under the age of 6
what happens when you take over 1000mg of dextromethorphan?
complete dissociation and hallucinations
what is a way we can improve patient understanding when it comes to medication?
convert children/infant doses to same concentration to prevent math errors
what is the definition of child resistant packaging?
designed to be significantly difficult for children under 5 to open or obtain a harmful amount of contents within a reasonable amount of time
what is the first step for treatment of poisoning?
determine if the patient has symptoms and if the exposure puts the patient at risk of toxicity
what is the number 1 cause of injury and death in the United States from?
drug poisoning
how can pharmacist play a role in the misuse of drugs?
drug take back programs educate parents and grandparents health literacy
what are some risks associated with abusing a laxative?
electrolyte imbalance nutritional deficiencies
what are first generation antihistamines abused/used for?
euphoric effect, high energy, positive mood
when is self care only appropriate in terms of poisoning?
exposure was unintentional toxicity risk is assessed to be minor
what is tetrahydrozoline?
eye drops
what happens when you take over 200mg of dextromethrophan?
hearing/visual perception changes
when does activated charcoal work best?
if administered within 1 hour of poisoning
what is the mechanism of abuse for first generation antihistamines?
increase dopamine transmission
what are some risks associated with pseudoephedrine/ephedrine?
increases heart rate increases blood pressure elevates mood appetite suppression
what are non-pharmacologic ways for managing poisonings?
inhalation exposure- move to fresh air skin/mucosal exposure- irrigation -like wash off with soap and water -use water/saline solution to irrigate eyes ingestion- administer large amounts of fluids (but may cause vomiting)
what is the definition of misuse?
intent to treat therapeutic need
what are exclusions to self care treatment of poisonings?
intentional exposure/substance abuse expected suicide or homicide exposure with moderate to severe toxicity exhibiting life threatening clinical effects suspected child or elder abuse advanced age absent or poor gag reflex CNS depression
what is the mechanism of abuse for tetrahydrozoline?
it is lipophilic-so it has low systemic absorption crosses the BBB after ingestion to stimulate alpha 2 receptors and agonize imidazoline 1 receptor
what is one thing to consider about activated charcoal?
it is relatively safe, but not something that should be kept in a house (unless you live far from the hospital) due to its limited efficacy
what is dextromethorphan used/abused for?
its euphoric effect or "robotripping"
what is loperamide abused for?
its euphoric effects and also is used to avoid and treat opioid withdrawal
what are some ways pharmacists could prevent abuse/misuse of medications?
keep drugs out of sight (like behind the counter) question purchase of the medication refusal to sell referral to physician counsel about the abuse/misuse potential
does activated charcoal have a small or large absorption area?
large
what is a restriction the FDA did to loperamide?
limiting packages to a maximum of 48 mg
what is activated charcoal a poor adsorbent of?
lithium alcohols hydrocarbons mineral acids heavy metals cyanide saying: MALCHH
what is pseudoephedrine abused for?
making methamphetamine
why is acetaminophen the leading cause of poisoning?
misunderstandings confusion about use intentional misuse- easy access
what option would be best if you have to take dextromethorphan?
multi-ingredient products!
are there restrictions when purchasing tetrahydrozoline?
no!
what is the definition of abuse?
non-therapeutic use
what is pseudoephedrine/ephedrine structurally similar too?
norepinephrine
what is the home dose of activated charcoal?
one dose only!
how do we go about drug take back programs?
partner with local sheriffs department sell drug disposal products advertise for local events
also, at very high doses loperamide can combine with what inhibitor to enhance absorption in the CNS?
pgp inhibitor
who works at the poison control center?
pharmacists, nurses, physicians
what are patient education tips on using activated charcoal?
product should be shaken vigorously prior to administration some may include flavoring agents
what are the risks associated with abusing/misusing first generation antihistamines?
psychosis changes in heart rhythm urinary retention CNS depression
what happens when you take 100-120mg of dextromethorphan?
restlessness and euphoria
what are risk associated with taking too much dextromethrophan?
serotonin syndrome QT prolongation CNS depression death
what is pseudoephedrine/ephedrine abused for?
stimulant properties
what is the most common abused laxative class?
stimulants
what is syncope?
sudden drop in your blood pressure, that might cause you to faint
what are some examples of drug poisonings that might be accidental or intentional in adults?
suicide attempt substance abuse medication misuse
what can a hospital do if you have drug poisoning?
supportive care: keep airways open fluid prevent absorption increase elimination utilize antidotes
what is the mechanism of abuse for pseudoephedrine/ephedrine?
sympathomimetics
what does social media have to do with first generation antihistamines?
there is a Benadryl challenge and also NyQuil challenge
What is the poison prevention packaging act of 1970 purpose?
to prevent children under 5 from accidental poisoning and death it allowed for child resistant closures of Rx and non Rx drugs
list 2 ways people are exposed to drugs.
topical ingestion
are poisonings intentional or unintentional in children typically?
unintentional
what is the mechanism of abuse for a laxative?
used to stimulate bowel movements (purging)
what are clinical presentations of poisonings?
vary depending on the drug may mimic side effect profile with normal use others may have widespread organ effects signs/symptoms may be delayed
what are common adverse reactions of using activated charcoal?
vomiting black stool
what is the mechanism of abuse for loperamide?
weak opioid receptor agonist in the gastrointestinal tract
what are laxatives abused for?
weight loss
how is tetrahydrozoline abused?
when it is ingested orally
can I use activated charcoal at home?
yes
are there restrictions on laxatives?
yes in the UK retail outlets can sell to people over the age of 18 pharmacists can see for use in 12 and older
are there restrictions on pseudoephedrine?
yes it is now sold behind the counter at the pharmacy and there's restriction on purchases of this to daily and monthly
are there restrictions on buying dextromethrophan?
yes only in some states you must be 18 years or older in order to purchase this