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Tricyclics have a narrow therapeutic index, i.e., the therapeutic dose is close to the toxic dose. [7] Factors that increase the risk of toxicity include advancing age, cardiac status, and concomitant use of other drugs. [8] However, serum drug levels are not useful for evaluating risk of arrhythmia or seizure in tricyclic overdose. [9]
Animal studies showed that these compounds lowered blood glucose levels. Some less toxic derivatives, synthalin A and synthalin B, were used for diabetes treatment, but after the discovery of insulin, their use declined. Biguanides were reintroduced into Type 2 diabetes treatment in the late 1950s.
The most common symptoms of overdose include central nervous system (CNS) depression, impaired balance, ataxia, and slurred speech. Severe symptoms include coma and respiratory depression. Supportive care is the mainstay of treatment of benzodiazepine overdose. There is an antidote, flumazenil, but its use is controversial. [2]
Acute toxicity is distinguished from chronic toxicity, which describes the adverse health effects from repeated exposures, often at lower levels, to a substance over a longer time period (months or years). It is widely considered unethical to use humans as test subjects for acute (or chronic) toxicity research.
In this case, both the therapeutic and toxic targets are the same. To avoid toxicity during treatment, many times the drug needs to be changed to target a different aspect of the illness or symptoms. Statins are an example of a drug class that can have toxic effects at the therapeutic target (HMG CoA reductase). [1]
The symptoms can often be divided into differing toxidromes. This can help one determine what class of drug or toxin is causing the difficulties. Symptoms of opioid overdoses include slow breathing, heart rate and pulse. [6] Opioid overdoses can also cause pinpoint pupils, and blue lips and nails due to low levels of oxygen in the blood.
Structure of chlorhexidine, a bisbiguanide antiseptic.. Bisbiguanides are a class of chemically related compounds known for their bactericidal properties. Generally considered to be of the generic formula: R 1 R 2 N.C(:NR 6)NH.C(:NH)NH.CH 2 X--(CH 2) 3 NH.C(:NH)NH.C(:NR 7)NR 3 R 4 V. [1] These compounds include the antiseptics chlorhexidine and alexidine.
Research has shown that excessive alcohol use causes an 8-fold increased risk of psychotic disorders in men and a 3 fold increased risk of psychotic disorders in women. [11] [12] While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent. [8]