Expert opinion on drug safety
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Expert Opin Drug Saf · May 2004
ReviewThe pharmacology of bipolar disorder during pregnancy and breastfeeding.
Treating bipolar disorder in women during reproduction presents a significant challenge to the physician. The pharmaceutical agents most commonly used for treating bipolar disorder have been associated with adverse effects when used during pregnancy and breastfeeding. Of particular concern has been the association of lithium with cardiac malformations, and the association of carbamazepine and valproate with neural tube defects including spina bifida. ⋯ Treatment options for mood stabilisation are either associated with risks of adverse events, have been used less frequently and their associated risks are unknown, or may not provide effective prophylaxis against recurrences of bipolar episodes. However, strategies are available that minimise the risk to the fetus and infant whilst still providing effective prophylaxis against bipolar disorder in the mother. Ideally, a treatment regimen tailored to suit the individual should consider both mother and baby and should be planned prior to conception.
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Expert Opin Drug Saf · May 2004
EditorialMedication errors resulting from the confusion of drug names.
If drug names are similar, errors can occur. Problems arise when different drugs have similar names (whether proprietary or non-proprietary), when formulations with the same brand name contain different drugs, when the same drug is marketed in formulations with different names, and when drug names are abbreviated. ⋯ Before they write an unfamiliar name on a prescription, prescribers should check what they are prescribing and what other medications the patient is taking (patients should be familiar with their medicines), and pharmacists should check patients' medicines. At all times there should be good communication among those who prescribe, supply, and administer medicines, and those who take them.
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The use of hypotonic intravenous solutions, especially 4% dextrose/0.18% saline, remains standard practice in many paediatric units in the UK. The practice of prescribing hypotonic intravenous fluids derives from the work of investigators in the 1950s, who produced arbitrarily-derived formulae for calculating the maintenance requirements for water and electrolytes in hospitalised patients. Combining these values led to the widespread acceptance of hypotonic solutions such as 4% dextrose/0.18% saline as 'standard maintenance' parenteral fluids. ⋯ The problem is compounded by the fact that 4% dextrose/0.18% saline is labelled as 'isotonic'. Whilst this solution is isosmolar compared to plasma, lack of osmotically-effective solutes means that it is hypotonic with reference to the cell membrane. There is no justification for the routine administration of hypotonic intravenous fluids.
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A large number of drugs may be responsible for the development of nail changes, including cancer chemotherapeutic agents and retinoids, however, only a few classes of drugs are consistently associated with nail symptoms. Drug-induced nail abnormalities result from toxicity to the matrix, the nail bed, the periungual tissues or the digit blood vessels. ⋯ Drug-induced nail changes usually involve several or all of the nails. In most cases, nail abnormalities are asymptomatic, but can sometimes cause pain and impair manual activities.
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Expert Opin Drug Saf · Nov 2003
ReviewTorsade de pointes associated with the administration of intravenous haloperidol:a review of the literature and practical guidelines for use.
Haloperidol is the most commonly used medication for the treatment of delirium and psychosis in the critically ill patient. Whilst generally considered to be safe, haloperidol has been associated with a number of important cardiovascular side effects. ⋯ The management of torsade de pointes consists of discontinuation of the possible offending agent(s), correction of electrolyte abnormalities, administration of magnesium sulfate and, if necessary, overdrive pacing. Although clinicians should be aware of this potentially lethal complication of intravenous haloperidol therapy, it should not deter clinicians from using intravenous haloperidol to treat acute agitation in the critically ill patient with a normal QTc.